Provider Demographics
NPI:1003330838
Name:SARASOTA SPINE & SPORT CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:SARASOTA SPINE & SPORT CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-926-1600
Mailing Address - Street 1:3900 CLARK RD STE H1
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2366
Mailing Address - Country:US
Mailing Address - Phone:941-926-1600
Mailing Address - Fax:941-926-1166
Practice Address - Street 1:5517 21ST AVE W STE F
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5604
Practice Address - Country:US
Practice Address - Phone:941-321-9002
Practice Address - Fax:941-926-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7276950002OtherDME