Edx of Brevard, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

EDX OF BREVARD, LLC

Practice address

2955 Pineda Plaza Way Ste 104
Melbourne, FL 32940-7306

Phone

(321) 213-8101

Fax

(844) 228-4426

NPI assigned

Apr 10, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert Ville, DC

Title

President/Owner

Phone

(321) 213-8101

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586476800000",
    "number": "1104445048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2955 PINEDA PLAZA WAY STE 104",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329407306",
            "telephone_number": "321-213-8101",
            "fax_number": "844-228-4426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2955 PINEDA PLAZA WAY STE 104",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329407306",
            "telephone_number": "321-213-8101",
            "fax_number": "844-228-4426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDX OF BREVARD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-10",
        "last_updated": "2020-04-10",
        "certification_date": "2020-04-10",
        "status": "A",
        "authorized_official_last_name": "VILLE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "321-213-8101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.