Provider Demographics
NPI:1184457707
Name:BRICE, MAHALIA (DC)
Entity type:Individual
Prefix:
First Name:MAHALIA
Middle Name:
Last Name:BRICE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 S DIXIE HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-1539
Mailing Address - Country:US
Mailing Address - Phone:561-650-1205
Mailing Address - Fax:
Practice Address - Street 1:3030 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-1539
Practice Address - Country:US
Practice Address - Phone:561-650-1205
Practice Address - Fax:561-650-1206
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor