Samantha Bergoine, D.C.
Individual provider Active NPI Chiropractor · Edgewater, FL
NPI 1114668019 · NPPES record last updated Mar 21, 2023
Key facts
- NPI
- 1114668019
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CH13852 (FL)
- Practice address
- 3042 S Ridgewood Ave
Edgewater, FL 32141-5903 - Phone
- (386) 287-1372
- NPI assigned
- Apr 5, 2022
- Reactivated
- Mar 21, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH13852 | FL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pure Chiropractic & Yoga | Chiropractor | Current |
Accepting new patients |
Locations
3042 S Ridgewood Ave
Edgewater, FL 32141
Phone (386) 287-1372
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH13852 | FL | Yes |
Addresses
Primary practice location
3042 S Ridgewood Ave
Edgewater, FL 32141-5903
Mailing address
2819 S Asciano CT
New Smyrna Beach, FL 32168-6322
Other practice location 1
2819 S Asciano Ct
New Smyrna Beach, FL 32168-6322
Phone (954) 610-9738
Other providers in Edgewater, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.