Provider Demographics
NPI:1649240771
Name:KIRSCHENBERG, BRUCE HAL (DC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:HAL
Last Name:KIRSCHENBERG
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 1:36 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3504
Mailing Address - Country:US
Mailing Address - Phone:954-428-7500
Mailing Address - Fax:954-428-7502
Practice Address - Street 1:36 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3504
Practice Address - Country:US
Practice Address - Phone:954-428-7500
Practice Address - Fax:954-428-7502
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050667200Medicaid
FL70394BMedicare ID - Type Unspecified
FL050667200Medicaid