Healthcare Provider Details

I. General information

NPI: 1497170047
Provider Name (Legal Business Name): SUE BEDAIR D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 BROADWAY
DUNEDIN FL
34698-5756
US

IV. Provider business mailing address

1059 BROADWAY
DUNEDIN FL
34698-5756
US

V. Phone/Fax

Practice location:
  • Phone: 727-733-6501
  • Fax: 727-733-6701
Mailing address:
  • Phone: 727-733-6501
  • Fax: 727-733-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: