Provider Demographics
NPI:1609973304
Name:BICKERTON, BRIAN ROSS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROSS
Last Name:BICKERTON
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 1:4214 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1605
Mailing Address - Country:US
Mailing Address - Phone:727-376-7339
Mailing Address - Fax:727-372-2452
Practice Address - Street 1:4214 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1605
Practice Address - Country:US
Practice Address - Phone:727-376-7339
Practice Address - Fax:727-372-2452
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55923OtherBC/BS OF FLORIDA
FL1164565453OtherNPI ORGANIZATION
FLK1803Medicare ID - Type UnspecifiedMEDICARE CLINIC
FL1164565453OtherNPI ORGANIZATION
FL55923OtherBC/BS OF FLORIDA