MEDICARE: DR. DAVID BRYAN KIRCHOFER D.C.

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	365	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70700	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1407821788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BRYAN KIRCHOFER D.C.

Provider Business Mailing Address
First Line	:	5505 N ATLANTIC AVE
Second Line	:	SUITE 104
City	:	COCOA BEACH
State	:	FL
Zip	:	32931-3226
Country	:	US
Telephone Number	:	321-784-0888
Fax Number	:	321-784-0888

Provider Business Practice Location Address
First Line	:	5505 N ATLANTIC AVE
Second Line	:	SUITE 104
City	:	COCOA BEACH
State	:	FL
Zip	:	32931-5111
Country	:	US
Telephone Number	:	321-784-0888
Fax Number	:	321-784-0888

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	11/05/2013

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