Provider Demographics
NPI:1497987135
Name:HRISTAKOPOULOS, BERNADETTE (DC)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:HRISTAKOPOULOS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:
Other - Last Name:DILIBERTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 LEANNI WAY UNIT D1
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 LEANNI WAY
Practice Address - Street 2:SUITE D1
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4751
Practice Address - Country:US
Practice Address - Phone:386-283-5997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor