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Organization
JENNIFER C BOURST DC PA
Active
Organization
JENNIFER C BOURST DC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER C BOURST DC PA (PRESIDENT)
(407) 654-4506
Entity
Organization
Contact information
Practice address
13750 W COLONIAL DR, SUITE 318, WINTER GARDEN, FL 34787-4204
(407) 654-4506
(407) 654-4506
Mailing address
13750 W COLONIAL DR, SUITE 318, WINTER GARDEN, FL 34787-4204
(407) 654-4506
(407) 654-4506
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH 7986
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K8143
GROUP IDENTIFICATION NUMB
FL
Enumeration date
11/14/2007
Last updated
03/25/2008
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