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General NPI Number Information
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NPI Number | 1972631190
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Entity Type | Organization
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Legal Business Name | BAGNELL CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 7600 S RED RD
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5428
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Country | US
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Telephone | 305-661-4303
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Fax | 305-661-7558
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Provider Business Mailing Address
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Address Line | 7600 S RED RD
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5428
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Country | US
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Telephone | 305-661-4303
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Fax | 305-661-7558
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Authorized Official
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Title or Position | DOCTOR,PRESIDENT
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Name | DR. MICHAEL KEITH BAGNELL
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Credential | D.C.
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Telephone | 305-661-4303
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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 | CH5986
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License Number State | FL
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