MEDICARE: DR. DAVID A. BOERSMA D.C.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	111N00000X	Chiropractor	CH10083	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841562071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A. BOERSMA D.C.P.A.

Provider Business Mailing Address
First Line	:	1590 US 27 N
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-2151
Country	:	US
Telephone Number	:	863-453-5777
Fax Number	:	863-453-9737

Provider Business Practice Location Address
First Line	:	1590 US 27 N
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-2151
Country	:	US
Telephone Number	:	863-453-5777
Fax Number	:	863-453-9737

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

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	07/06/2012

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Directions to “ DR. DAVID A. BOERSMA D.C.P.A.” Practice Location

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