MEDICARE: DR. NANCY M BERTELMANN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH11702	FL

General Provider Information

NPI Number	:	1003270307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY M BERTELMANN DC

Provider Business Mailing Address
First Line	:	308 W HIGHLAND DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1543
Country	:	US
Telephone Number	:	863-337-5013
Fax Number	:	863-337-5020

Provider Business Practice Location Address
First Line	:	308 W HIGHLAND DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1543
Country	:	US
Telephone Number	:	863-337-5013
Fax Number	:	863-337-5020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	04/12/2016

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