Provider Demographics
NPI:1093929176
Name:KIRCHNER, BRUCE DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:DAVID
Last Name:KIRCHNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 37TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7321
Mailing Address - Country:US
Mailing Address - Phone:772-978-7808
Mailing Address - Fax:772-978-9320
Practice Address - Street 1:1355 37TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7321
Practice Address - Country:US
Practice Address - Phone:772-978-7808
Practice Address - Fax:772-978-9320
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2552174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGQ309ZMedicare PIN