Provider Demographics
NPI:1548424716
Name:BRAVARD CHIROPRACTIC INC
Entity type:Organization
Organization Name:BRAVARD CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:BRAVARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-508-5870
Mailing Address - Street 1:1523 47TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7089
Mailing Address - Country:US
Mailing Address - Phone:309-764-7272
Mailing Address - Fax:309-764-7272
Practice Address - Street 1:1523 47TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7089
Practice Address - Country:US
Practice Address - Phone:309-764-7272
Practice Address - Fax:309-764-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty