Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH10705 | FL |
N | 111NN1001X | Nutrition | CH10705 | FL |
NPI | 1356680128 |
---|---|
Provider Name | Dr. Justin James Bartlett |
First Address | Palm Beach Gardens, FL 33418-3831 |
Second Address | Palm Beach Gardens, FL 33418-3831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2013 |
Last Update Date | 29/03/2013 |