Provider Demographics
NPI:1023751534
Name:BB CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BB CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNTJER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-308-2979
Mailing Address - Street 1:940 VILLAGE TRL UNIT 4-302
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9380
Mailing Address - Country:US
Mailing Address - Phone:507-531-6476
Mailing Address - Fax:
Practice Address - Street 1:357 WEKIVA SPRINGS RD STE 3
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3607
Practice Address - Country:US
Practice Address - Phone:407-308-2979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center