Provider Demographics
NPI:1932105251
Name:HANSBROUGH, BRUCE ALAN SR (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:HANSBROUGH
Suffix:SR
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 1:11764 SW VALENCIA CT
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990
Mailing Address - Country:US
Mailing Address - Phone:772-285-2133
Mailing Address - Fax:772-219-8113
Practice Address - Street 1:3007 SW MARTIN DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2644
Practice Address - Country:US
Practice Address - Phone:772-288-6456
Practice Address - Fax:772-288-4195
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2016-02-03
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
FLCH6770111NX0100X
GACH05052111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007187200Medicaid
FL55239Medicare PIN
FLU54185Medicare UPIN