Provider Demographics
NPI:1245486562
Name:BRIDGEWATER CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:BRIDGEWATER CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:305-788-8885
Mailing Address - Street 1:99 BRIDGE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2956
Mailing Address - Country:US
Mailing Address - Phone:724-371-0280
Mailing Address - Fax:724-888-2458
Practice Address - Street 1:99 BRIDGE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2956
Practice Address - Country:US
Practice Address - Phone:724-371-0280
Practice Address - Fax:724-888-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
PADC009970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty