MEDICARE: MR. ROBERT LANCE BRIDGES D.C.

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	CHIR010466	GA
2	111N00000X	Chiropractor	CH13563	FL

General Provider Information

NPI Number	:	1487241030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT LANCE BRIDGES D.C.

Provider Business Mailing Address
First Line	:	1605 COUNTRY ROAD 220 STE 165
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003
Country	:	US
Telephone Number	:	904-712-3548
Fax Number	:	904-712-3813

Provider Business Practice Location Address
First Line	:	1605 COUNTY ROAD 220 STE 165
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4910
Country	:	US
Telephone Number	:	904-712-3548
Fax Number	:	904-712-3813

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

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	04/26/2024

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Directions to “ MR. ROBERT LANCE BRIDGES D.C.” Practice Location

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