MEDICARE: KELVIN BRITO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	12967	FL

General Provider Information

NPI Number	:	1386281939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELVIN BRITO

Provider Business Mailing Address
First Line	:	5400 CORACI BLVD APT 3309
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-7572
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 AVALON PARK SOUTH BLVD STE 1000
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6703
Country	:	US
Telephone Number	:	407-930-3696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	12/03/2019

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Directions to “ KELVIN BRITO ” Practice Location

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