Provider Demographics
NPI:1841562071
Name:BOERSMA, DAVID A (DCPA)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:BOERSMA
Suffix:
Gender:M
Credentials:DCPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 US 27 N
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2151
Mailing Address - Country:US
Mailing Address - Phone:863-453-5777
Mailing Address - Fax:863-453-9737
Practice Address - Street 1:1590 US 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2151
Practice Address - Country:US
Practice Address - Phone:863-453-5777
Practice Address - Fax:863-453-9737
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFU690ZMedicare PIN