Active NPI
Daniel J Bourassa, DC PHD
- Chiropractor
- Gulf Breeze, FL
National Provider Identifier
1043227994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH 6116
- Practice address
- 103 Nightingale LN
Gulf Breeze, FL 32561-4300 - Phone
- (850) 250-2730
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH 6116 | FL | Primary |
Addresses
Primary practice location
103 Nightingale LN
Gulf Breeze, FL 32561-4300
Mailing address
1400 E de Soto St
Pensacola, FL 32501-3439
Phone (850) 250-2730
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CH0006116 | Other | FL | LICENSE FOR FLORIDA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH 6116 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559520000000",
"number": "1043227994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 E DE SOTO ST",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325013439",
"telephone_number": "850-250-2730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 NIGHTINGALE LN",
"city": "GULF BREEZE",
"state": "FL",
"postal_code": "325614300",
"telephone_number": "850-250-2730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURASSA",
"first_name": "DANIEL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DC PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2019-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH 6116",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE FOR FLORIDA",
"identifier": "CH0006116",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gulf Breeze, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.