Provider Demographics
NPI:1295737757
Name:BERVEN, LYNETTE (DC)
Entity type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:
Last Name:BERVEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6534 GUNN HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4022
Mailing Address - Country:US
Mailing Address - Phone:813-968-3500
Mailing Address - Fax:813-968-3555
Practice Address - Street 1:6534 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4022
Practice Address - Country:US
Practice Address - Phone:813-968-3500
Practice Address - Fax:813-968-3555
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003466000Medicaid
ER347AMedicare PIN