Provider Demographics
NPI:1629638069
Name:CALIXTO BEJARANO, FABIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:FABIAN
Middle Name:
Last Name:CALIXTO BEJARANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 CURLEW RD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9330
Mailing Address - Country:US
Mailing Address - Phone:727-600-8024
Mailing Address - Fax:
Practice Address - Street 1:2323 CURLEW RD STE 7E
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9332
Practice Address - Country:US
Practice Address - Phone:727-600-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor