Provider Demographics
NPI:1417035940
Name:MACDERMOTT, BRET J (DC, DACS)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:J
Last Name:MACDERMOTT
Suffix:
Gender:M
Credentials:DC, DACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 MALLORY CIR
Mailing Address - Street 2:STE 205
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1818
Mailing Address - Country:US
Mailing Address - Phone:407-507-6976
Mailing Address - Fax:888-808-4097
Practice Address - Street 1:2940 MALLORY CIR
Practice Address - Street 2:STE 205
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-1818
Practice Address - Country:US
Practice Address - Phone:407-507-6976
Practice Address - Fax:888-808-4097
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1618111N00000X
FLCH9737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0580ZOtherMEDICARE INDIVIDUAL
FL2201BOtherBCBS
FLC0580ZOtherMEDICARE INDIVIDUAL