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General NPI Number Information
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NPI Number | 1881697035
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Entity Type | Organization
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Legal Business Name | BRANDON MEDICAL WELLNESS CENTER
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 807 S PARSONS AVE
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City | BRANDON
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State | FL
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Zip | 33511-6063
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Country | US
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Telephone | 813-684-8141
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Fax | 813-689-1140
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Provider Business Mailing Address
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Address Line | 807 S PARSONS AVE
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City | BRANDON
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State | FL
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Zip | 33511-6063
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Country | US
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Telephone | 813-684-8141
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Fax | 813-689-1140
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Authorized Official
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Title or Position | OWNER
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Name | JOHN S MORGAN
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Credential | DC
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Telephone | 813-684-8141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH0005360
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH9344
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME46540
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT9814
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH0005666
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License Number State | FL
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