Provider Demographics
NPI:1245031368
Name:BURGOS VALDESPINO, BRYAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:BURGOS VALDESPINO
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17455 NW 94TH CT APT 220
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4444
Mailing Address - Country:US
Mailing Address - Phone:787-312-1612
Mailing Address - Fax:
Practice Address - Street 1:15426 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5803
Practice Address - Country:US
Practice Address - Phone:305-699-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor