Provider Demographics
NPI:1740548130
Name:DR. SANDY BRAVAR D.C., P.A.
Entity type:Organization
Organization Name:DR. SANDY BRAVAR D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENS/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:BRAVAR
Authorized Official - Last Name:CORRITORI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-632-6822
Mailing Address - Street 1:5600 PGA BLVD
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3900
Mailing Address - Country:US
Mailing Address - Phone:561-632-6822
Mailing Address - Fax:561-624-4349
Practice Address - Street 1:5600 PGA BLVD
Practice Address - Street 2:SUITE 104A
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3900
Practice Address - Country:US
Practice Address - Phone:561-632-6822
Practice Address - Fax:561-624-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty