MEDICARE: BERMUDEZ CHIROPRACTIC CENTER, P.A.

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	302R00000X	Health Maintenance Organization	CH8963	FL

General Provider Information

NPI Number	:	1073751863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERMUDEZ CHIROPRACTIC CENTER, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 61
Second Line	:
City	:	ESTERO
State	:	FL
Zip	:	33929-0061
Country	:	US
Telephone Number	:	239-919-9899
Fax Number	:	239-313-5427

Provider Business Practice Location Address
First Line	:	4801 PALM BEACH BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-3214
Country	:	US
Telephone Number	:	239-313-5427
Fax Number	:	239-313-5427

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. JACQUELINE BERMUDEZ
Credential	:	DC
Telephone Number	:	239-919-9899

Provider Enumeration Date	:	02/02/2009
Last Update Date	:	04/19/2011

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