Provider Demographics
NPI:1801532205
Name:DIBERNARDO-BOGARDUS, VICTORIA LUISA (DC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LUISA
Last Name:DIBERNARDO-BOGARDUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:LUISA
Other - Last Name:DIBERNARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:50 VALENTINE ST UNIT 14B
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07750-1452
Mailing Address - Country:US
Mailing Address - Phone:732-241-1610
Mailing Address - Fax:
Practice Address - Street 1:174 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4177
Practice Address - Country:US
Practice Address - Phone:732-345-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00370200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor