Provider Demographics
NPI:1396035655
Name:BRANDON BACK PAIN RELIEF CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BRANDON BACK PAIN RELIEF CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:F
Authorized Official - Last Name:POLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-654-7121
Mailing Address - Street 1:166 E BLOOMINGDALE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8101
Mailing Address - Country:US
Mailing Address - Phone:813-654-7121
Mailing Address - Fax:813-200-3986
Practice Address - Street 1:166 E BLOOMINGDALE AVE STE B
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8101
Practice Address - Country:US
Practice Address - Phone:813-654-7121
Practice Address - Fax:813-200-3986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID