Provider Demographics
NPI:1356427421
Name:BRIDGWOOD, DAVID B (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:BRIDGWOOD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 W MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5220
Mailing Address - Country:US
Mailing Address - Phone:516-561-4060
Mailing Address - Fax:516-561-5392
Practice Address - Street 1:417 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5220
Practice Address - Country:US
Practice Address - Phone:516-561-4060
Practice Address - Fax:516-561-5392
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005938111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX36851Medicare UPIN