Provider Demographics
NPI:1003026485
Name:BASS, DAVID BRIAN (DC, AP)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRIAN
Last Name:BASS
Suffix:
Gender:M
Credentials:DC, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9737 NW 65TH PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2315
Mailing Address - Country:US
Mailing Address - Phone:954-649-6540
Mailing Address - Fax:
Practice Address - Street 1:1560 SAWGRASS CORPORATE PKWY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2858
Practice Address - Country:US
Practice Address - Phone:954-649-6540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3178111N00000X
FLAP1911171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCV878AOtherMEDICARE PTAN#