Provider Demographics
NPI:1760775472
Name:A.M.A. OF BERVARD, INC.
Entity type:Organization
Organization Name:A.M.A. OF BERVARD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKFORD
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:772-467-9083
Mailing Address - Street 1:1905 S 25TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4739
Mailing Address - Country:US
Mailing Address - Phone:772-467-9083
Mailing Address - Fax:772-464-6478
Practice Address - Street 1:1905 S 25TH ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4739
Practice Address - Country:US
Practice Address - Phone:772-467-9083
Practice Address - Fax:772-464-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP855171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty