Provider Demographics
NPI:1942514443
Name:DR ALEXIS BERGAN-GUZMAN DC PA
Entity Type:Organization
Organization Name:DR ALEXIS BERGAN-GUZMAN DC PA
Other - Org Name:SALVE CENTER FOR CHIROPRACTIC AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERGAN-GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-850-0704
Mailing Address - Street 1:671 NW 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6108
Mailing Address - Country:US
Mailing Address - Phone:954-850-0704
Mailing Address - Fax:
Practice Address - Street 1:116 NW 5TH STREET
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428
Practice Address - Country:US
Practice Address - Phone:954-850-0704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty