MEDICARE: DR. SANDY BRAVAR D.C., P.A.

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	CH9085	FL

General Provider Information

NPI Number	:	1740548130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SANDY BRAVAR D.C., P.A.

Provider Business Mailing Address
First Line	:	5600 PGA BLVD
Second Line	:	SUITE 104A
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3900
Country	:	US
Telephone Number	:	561-632-6822
Fax Number	:	561-624-4349

Provider Business Practice Location Address
First Line	:	5600 PGA BLVD
Second Line	:	SUITE 104A
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3900
Country	:	US
Telephone Number	:	561-632-6822
Fax Number	:	561-624-4349

Authorized Official
Title or Position	:	PRESIDENS/CHIROPRACTIC PHYSICIAN
Name	:	DR. SANDY BRAVAR CORRITORI
Credential	:	D.C.
Telephone Number	:	561-632-6822

Provider Enumeration Date	:	04/24/2012
Last Update Date	:	04/24/2012

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