Provider Demographics
NPI:1124357280
Name:DR. SANDY BRAVAR D.C., P.A.
Entity Type:Organization
Organization Name:DR. SANDY BRAVAR D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAVAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-632-6822
Mailing Address - Street 1:5600 PGA BOULEVARD
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418
Mailing Address - Country:US
Mailing Address - Phone:561-632-6822
Mailing Address - Fax:
Practice Address - Street 1:5600 PGA BOULEVARD
Practice Address - Street 2:SUITE 104A
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418
Practice Address - Country:US
Practice Address - Phone:561-632-6822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62841ZMedicare UPIN