Provider Demographics
NPI:1952471997
Name:BOURST, JENNIFER C (DC PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:BOURST
Suffix:
Gender:F
Credentials:DC PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13750 W COLONIAL DR
Mailing Address - Street 2:SUITE 318
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4204
Mailing Address - Country:US
Mailing Address - Phone:407-654-4506
Mailing Address - Fax:407-654-4506
Practice Address - Street 1:13750 W COLONIAL DR
Practice Address - Street 2:SUITE 318
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4204
Practice Address - Country:US
Practice Address - Phone:407-654-4506
Practice Address - Fax:407-654-4506
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor