Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH11058 | FL |
N | 111NR0400X | Rehabilitation Chiropractor | CH11058 | FL |
N | 111NS0005X | Chiropractic Sports Physician | CH11058 | FL |
NPI | 1093145278 |
---|---|
Provider Name | Dr. Bryan Story |
First Address | Wesley Chapel, FL 33544-6788 |
Second Address | Wesley Chapel, FL 33544-6788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2013 |
Last Update Date | 25/11/2013 |