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General NPI Number Information
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NPI Number | 1134209919
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Entity Type | Organization
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Legal Business Name | BIBCO INC
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 06/28/2011
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Provider Practice Location Address
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Address Line | 601 E CALL ST
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City | STARKE
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State | FL
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Zip | 32091
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Country | US
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Telephone | 904-964-8018
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Fax | 904-964-9131
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Provider Business Mailing Address
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Address Line | 601 E CALL ST
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City | STARKE
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State | FL
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Zip | 32091
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Country | US
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Telephone | 904-964-8018
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Fax | 904-964-9131
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Authorized Official
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Title or Position | OWNER
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Name | VIRGIL A BERRY JR.
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Credential | DC
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Telephone | 904-964-8018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH5217
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License Number State | FL
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