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General NPI Number Information
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NPI Number | 1750656526
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC HEALTH & AWARENESS CENTER, LLC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 860 111TH AVE N SUITE #7
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City | NAPLES
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State | FL
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Zip | 34108-1829
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Country | US
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Telephone | 239-260-5644
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Fax | 239-260-5646
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Provider Business Mailing Address
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Address Line | 860 111TH AVE N SUITE #7
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City | NAPLES
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State | FL
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Zip | 34108-1829
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Country | US
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Telephone | 239-260-5644
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Fax | 239-260-5646
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. MATTHEW BERGTOLD
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Credential | D.C.
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Telephone | 239-260-5644
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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 | 9083
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License Number State | FL
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