Provider Demographics
NPI:1316060080
Name:BELLOMO, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BELLOMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6442 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4204
Mailing Address - Country:US
Mailing Address - Phone:407-295-1077
Mailing Address - Fax:
Practice Address - Street 1:6442 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4204
Practice Address - Country:US
Practice Address - Phone:407-295-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70937OtherBCBS
FL70937Medicare ID - Type Unspecified
FL70937OtherBCBS