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General NPI Number Information
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NPI Number | 1942514443
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Entity Type | Organization
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Legal Business Name | DR ALEXIS BERGAN-GUZMAN DC PA
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 116 NW 5TH STREET
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428
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Country | US
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Telephone | 954-850-0704
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Fax |
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Provider Business Mailing Address
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Address Line | 671 NW 89TH AVE
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City | PLANTATION
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State | FL
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Zip | 33324-6108
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Country | US
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Telephone | 954-850-0704
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ALEXIS R BERGAN-GUZMAN
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Credential | DC
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Telephone | 954-850-0704
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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 | CH9941
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License Number State | FL
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