Provider Demographics
NPI:1407821788
Name:KIRCHOFER, DAVID BRYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRYAN
Last Name:KIRCHOFER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 N ATLANTIC AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3226
Mailing Address - Country:US
Mailing Address - Phone:321-784-0888
Mailing Address - Fax:321-784-0888
Practice Address - Street 1:5505 N ATLANTIC AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-5111
Practice Address - Country:US
Practice Address - Phone:321-784-0888
Practice Address - Fax:321-784-0888
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70700OtherBLUE CROSS