MEDICARE: DR. BONNIE LYN RUPPERT 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	CH10311	FL

General Provider Information

NPI Number	:	1538453220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BONNIE LYN RUPPERT D.C.

Provider Business Mailing Address
First Line	:	1924 WREN AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5635
Country	:	US
Telephone Number	:	772-405-7877
Fax Number	:

Provider Business Practice Location Address
First Line	:	4842 N KINGS HWY
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-2243
Country	:	US
Telephone Number	:	772-405-7877
Fax Number	:

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

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	05/31/2011

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