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General NPI Number Information
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NPI Number | 1548707490
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Entity Type | Organization
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Legal Business Name | BEACON CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 2306 CLEVELAND AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-3540
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Country | US
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Telephone | 239-537-1075
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Fax |
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Provider Business Mailing Address
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Address Line | 2306 CLEVELAND AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-3540
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Country | US
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Telephone | 239-537-1075
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. GERARDO ALFARO JR.
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Credential | D.C.
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Telephone | 239-537-1075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | CH11249
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License Number State | FL
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