Brevard Wellness Center LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AP855 Issued in FL

Legal business name

BREVARD WELLNESS CENTER LLC

Doing business as

Space Coast Wellness Center

Practice address

466 N Harbor City Blvd
Melbourne, FL 32935-6858

Phone

(321) 610-8935

NPI assigned

Jul 29, 2015

Last updated

Jul 29, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Christopher Bickford, OMD, LAC

Title

President

Phone

(321) 610-8935

Specialties & licenses 1

Addresses

Other names 1

• Space Coast Wellness Center Doing business as

Locations

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

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438128000000",
    "number": "1689059891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "436 BAHIA CT NW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329078700",
            "telephone_number": "321-610-8935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "466 N HARBOR CITY BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329356858",
            "telephone_number": "321-610-8935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-29",
        "last_updated": "2015-07-29",
        "status": "A",
        "authorized_official_last_name": "BICKFORD",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-610-8935",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OMD, LAC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "FL",
            "license": "AP855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Space Coast Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; 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.