Provider Demographics
NPI:1497170047
Name:BEDAIR, SUE (DC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:BEDAIR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5756
Mailing Address - Country:US
Mailing Address - Phone:727-733-6501
Mailing Address - Fax:727-733-6701
Practice Address - Street 1:1059 BROADWAY
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5756
Practice Address - Country:US
Practice Address - Phone:727-733-6501
Practice Address - Fax:727-733-6701
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor