Provider Demographics
NPI:1023889748
Name:BERENDES, CHRISTIAN TYLER (DC)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:TYLER
Last Name:BERENDES
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:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:TERRA CEIA
Mailing Address - State:FL
Mailing Address - Zip Code:34250-0187
Mailing Address - Country:US
Mailing Address - Phone:727-773-5532
Mailing Address - Fax:
Practice Address - Street 1:120 HORSESHOE LOOP RD
Practice Address - Street 2:
Practice Address - City:TERRA CEIA
Practice Address - State:FL
Practice Address - Zip Code:34250
Practice Address - Country:US
Practice Address - Phone:727-773-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor