Provider Demographics
NPI:1891755617
Name:BRACKEN, THOMAS PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PAUL
Last Name:BRACKEN
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 1:955 CANDLELIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601
Mailing Address - Country:US
Mailing Address - Phone:352-799-1977
Mailing Address - Fax:352-799-2252
Practice Address - Street 1:955 CANDLELIGHT BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601
Practice Address - Country:US
Practice Address - Phone:352-799-1977
Practice Address - Fax:352-799-2252
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381630300Medicaid
FL22893ZMedicare PIN
U42548Medicare UPIN