MEDICARE: BRYAN FORD DC

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	CH13986	FL

General Provider Information

NPI Number	:	1699400929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN FORD DC

Provider Business Mailing Address
First Line	:	1902 SW YELLOWTAIL AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-2478
Country	:	US
Telephone Number	:	248-892-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 10TH AVE N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-3100
Country	:	US
Telephone Number	:	561-540-4446
Fax Number	:

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

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	07/20/2022

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Directions to “ BRYAN FORD DC” Practice Location

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