Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH6925 | FL |
Y | 111NR0400X | Rehabilitation Chiropractor | CH6925 | FL |
NPI | 1336113786 |
---|---|
Provider Name | Bruce M Gelch |
First Address | Pembroke Pines, FL 33026-4101 |
Second Address | Pembroke Pines, FL 33026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 08/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
380928500 | (05) | FL |
U59325 | (02) |