1073751863 NPI number — BERMUDEZ CHIROPRACTIC CENTER, P.A.

Table of content: DR. JOSE NELSON RIVERA JR. M.D. (NPI 1396722948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073751863 NPI number — BERMUDEZ CHIROPRACTIC CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERMUDEZ CHIROPRACTIC CENTER, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073751863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 61
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESTERO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33929-0061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-919-9899
Provider Business Mailing Address Fax Number:
239-313-5427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4801 PALM BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33905-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-313-5427
Provider Business Practice Location Address Fax Number:
239-313-5427
Provider Enumeration Date:
02/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BERMUDEZ
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
239-919-9899

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  CH8963 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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