Provider Demographics
NPI:1609127067
Name:HEALTH SOLUTIONS OF BRANDON LLC
Entity Type:Organization
Organization Name:HEALTH SOLUTIONS OF BRANDON LLC
Other - Org Name:BACK AND NECK DOCTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-684-8141
Mailing Address - Street 1:807 S PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6063
Mailing Address - Country:US
Mailing Address - Phone:813-684-8041
Mailing Address - Fax:813-689-1140
Practice Address - Street 1:807 S PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6063
Practice Address - Country:US
Practice Address - Phone:813-684-8041
Practice Address - Fax:813-689-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003S2OtherBLUE CROSS BLUE SHIELD
FLGW06AMedicare PIN