Provider Demographics
NPI:1558343459
Name:HARCOURT, BRIAN TIMOTHY (DC FACO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TIMOTHY
Last Name:HARCOURT
Suffix:
Gender:M
Credentials:DC FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 COLLEGE PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5658
Mailing Address - Country:US
Mailing Address - Phone:239-278-3344
Mailing Address - Fax:239-278-3159
Practice Address - Street 1:7270 COLLEGE PKWY STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5658
Practice Address - Country:US
Practice Address - Phone:239-278-3344
Practice Address - Fax:239-278-3159
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9690111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
T30688Medicare UPIN
488768NLKMedicare ID - Type Unspecified