Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH 9690 | FL |
NPI | 1558343459 |
---|---|
Provider Name | Dr. Brian Timothy Harcourt |
First Address | Fort Myers, FL 33907-5658 |
Second Address | Fort Myers, FL 33907-5658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 21/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T30688 | (02) |