Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH3178 | FL |
NPI | 1003026485 |
---|---|
Provider Name | Dr. David Brian Bass |
First Address | Parkland, FL 33076-2315 |
Second Address | Sunrise, FL 33323-2858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 19/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CV878A | MEDICARE PTAN# (01) | FL |