Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH12071 | FL |
Y | 111NR0400X | Rehabilitation Chiropractor | CH12071 | FL |
NPI | 1225565252 |
---|---|
Provider Name | Bryan George Stone |
First Address | Coral Springs, FL 33067-2063 |
Second Address | Coral Springs, FL 33067-2063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2017 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CH12071 | DEPT OF HEALTH (01) | FL |