Healthcare Provider Details

I. General information

NPI: 1245486562
Provider Name (Legal Business Name): BRIDGEWATER CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BRIDGE ST SUITE 1
BEAVER PA
15009-2956
US

IV. Provider business mailing address

99 BRIDGE ST SUITE 1
BEAVER PA
15009-2956
US

V. Phone/Fax

Practice location:
  • Phone: 724-371-0280
  • Fax: 724-888-2458
Mailing address:
  • Phone: 724-371-0280
  • Fax: 724-888-2458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009970
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROLANDO BELLO JR.
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 305-788-8885