Provider Demographics
NPI:1679778724
Name:HABERMAN, BRUCE MARTIN (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MARTIN
Last Name:HABERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MENORCA CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-1050
Mailing Address - Country:US
Mailing Address - Phone:561-795-2010
Mailing Address - Fax:561-795-2010
Practice Address - Street 1:1501 MENORCA CT
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-1050
Practice Address - Country:US
Practice Address - Phone:561-795-2010
Practice Address - Fax:561-795-2010
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2367111N00000X
CADC11444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor