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General NPI Number Information
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NPI Number | 1073751863
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Entity Type | Organization
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Legal Business Name | BERMUDEZ CHIROPRACTIC CENTER, P.A.
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 04/19/2011
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Provider Practice Location Address
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Address Line | 4801 PALM BEACH BLVD
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City | FORT MYERS
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State | FL
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Zip | 33905-3214
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Country | US
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Telephone | 239-313-5427
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Fax | 239-313-5427
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Provider Business Mailing Address
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Address Line | PO BOX 61
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City | ESTERO
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State | FL
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Zip | 33929-0061
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Country | US
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Telephone | 239-919-9899
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Fax | 239-313-5427
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JACQUELINE BERMUDEZ
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Credential | DC
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Telephone | 239-919-9899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | CH8963
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License Number State | FL
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