Provider Demographics
NPI:1740203579
Name:BRAVO, DANIEL MARIO (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARIO
Last Name:BRAVO
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 1:1800 S.W. 27 AVE
Mailing Address - Street 2:SUITE 609
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145
Mailing Address - Country:US
Mailing Address - Phone:305-476-0347
Mailing Address - Fax:305-222-6199
Practice Address - Street 1:1800 S.W. 27 AVE.
Practice Address - Street 2:SUITE 609
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145
Practice Address - Country:US
Practice Address - Phone:305-476-0347
Practice Address - Fax:305-222-6199
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH7460OtherLIC#