Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH6579 | FL |
N | 111NN0400X | Neurology | CH6579 | FL |
N | 111NP0017X | Pediatric Chiropractor | CH6579 | FL |
N | 111NR0400X | Rehabilitation Chiropractor | CH6579 | FL |
N | 111NS0005X | Chiropractic Sports Physician | CH6579 | FL |
N | 111NX0100X | Occupational Health | CH6579 | FL |
N | 111NX0800X | Chiropractor Orthopedic Specialist | CH6579 | FL |
NPI | 1346605011 |
---|---|
Provider Name | Dr. Brian Mevorah |
First Address | Oakland Park, FL 33334-3928 |
Second Address | Oakland Park, FL 33334-3928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2015 |
Last Update Date | 23/12/2015 |