MEDICARE: CHARLENE ROSHELY SEIJO BERRIOS 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	CH15024	FL

General Provider Information

NPI Number	:	1164263240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE ROSHELY SEIJO BERRIOS DC

Provider Business Mailing Address
First Line	:	6315 PRESIDENTIAL CT STE 140
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3568
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6315 PRESIDENTIAL CT STE 140
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3568
Country	:	US
Telephone Number	:	941-697-3001
Fax Number	:

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

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	06/04/2024

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Directions to “ CHARLENE ROSHELY SEIJO BERRIOS DC” Practice Location

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