Provider Demographics
NPI:1073751863
Name:BERMUDEZ CHIROPRACTIC CENTER, P.A.
Entity Type:Organization
Organization Name:BERMUDEZ CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-919-9899
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33929-0061
Mailing Address - Country:US
Mailing Address - Phone:239-919-9899
Mailing Address - Fax:239-313-5427
Practice Address - Street 1:4801 PALM BEACH BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-3214
Practice Address - Country:US
Practice Address - Phone:239-313-5427
Practice Address - Fax:239-313-5427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8963302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization