MEDICARE: MR. BRAD DAVIS WHITTELSEY A.P.

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	171100000X	Acupuncturist	AP2654	FL

General Provider Information

NPI Number	:	1861635823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRAD DAVIS WHITTELSEY A.P.

Provider Business Mailing Address
First Line	:	4651 N STATE ROAD 7
Second Line	:	SUITE 9
City	:	COCONUT CREEK
State	:	FL
Zip	:	33073-4378
Country	:	US
Telephone Number	:	954-753-4248
Fax Number	:	954-255-7990

Provider Business Practice Location Address
First Line	:	4651 N STATE ROAD 7
Second Line	:	SUITE 9
City	:	COCONUT CREEK
State	:	FL
Zip	:	33073-4378
Country	:	US
Telephone Number	:	954-753-4248
Fax Number	:	954-255-7990

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

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	04/07/2009

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