MEDICARE: MIDNIGHT PASS CHIROPRACTIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	CH8486	FL

General Provider Information

NPI Number	:	1386926475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDNIGHT PASS CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	4012 CORTEZ RD W
Second Line	:	SUITE #2206
City	:	BRADENTON
State	:	FL
Zip	:	34210-3109
Country	:	US
Telephone Number	:	941-330-5233
Fax Number	:

Provider Business Practice Location Address
First Line	:	4012 CORTEZ RD W
Second Line	:	SUITE #2206
City	:	BRADENTON
State	:	FL
Zip	:	34210-3109
Country	:	US
Telephone Number	:	941-330-5233
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JONATHAN ALAN BERMAN
Credential	:	DC
Telephone Number	:	941-321-8800

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	09/14/2011

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