MEDICARE: DR. ELIZABETH L GONZALEZ BRUNO 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	CH 10746	FL
2	111NI0013X	Independent Medical Examiner Chiropractor	CH 10746	FL
3	111NR0400X	Rehabilitation Chiropractor	CH 10746	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	:	1962831289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH L GONZALEZ BRUNO DC

Provider Business Mailing Address
First Line	:	125 S STATE ROAD 7
Second Line	:	SUITE 104-274
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4385
Country	:	US
Telephone Number	:	954-336-9019
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 S STATE ROAD 7
Second Line	:	SUITE 103
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33414-4385
Country	:	US
Telephone Number	:	954-336-9019
Fax Number	:

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

Provider Enumeration Date	:	11/06/2013
Last Update Date	:	11/06/2013

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