Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | MA58018 | FL |
NPI | 1184991804 |
---|---|
Provider Name | Nicole Bernard |
First Address | Orlando, FL 32810-1085 |
Second Address | Orlando, FL 32811-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2011 |
Last Update Date | 23/11/2011 |