Provider Demographics
NPI:1861635823
Name:WHITTELSEY, BRAD DAVIS (AP)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:DAVIS
Last Name:WHITTELSEY
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4651 N STATE ROAD 7
Mailing Address - Street 2:SUITE 9
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4378
Mailing Address - Country:US
Mailing Address - Phone:954-753-4248
Mailing Address - Fax:954-255-7990
Practice Address - Street 1:4651 N STATE ROAD 7
Practice Address - Street 2:SUITE 9
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4378
Practice Address - Country:US
Practice Address - Phone:954-753-4248
Practice Address - Fax:954-255-7990
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2654171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist