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General NPI Number Information
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NPI Number | 1326454349
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Entity Type | Organization
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Legal Business Name | BARDMOOR CHIROPRACTIC CLINIC, PA
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 10801 STARKEY RD SUITE 303
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City | SEMINOLE
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State | FL
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Zip | 33777-1159
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Country | US
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Telephone | 727-280-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 10801 STARKEY RD SUITE 303
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City | SEMINOLE
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State | FL
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Zip | 33777-1159
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Country | US
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Telephone | 727-280-2323
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIANNE MICHELLE FERNANDEZ
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Credential | D.C.
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Telephone | 727-280-2323
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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 | 5777
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License Number State | FL
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