Provider Demographics
NPI:1164894895
Name:BEE RIDGE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BEE RIDGE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:ETHAN
Authorized Official - Last Name:BOGACZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-210-3637
Mailing Address - Street 1:3400 BEE RIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-7243
Mailing Address - Country:US
Mailing Address - Phone:941-210-3637
Mailing Address - Fax:
Practice Address - Street 1:3400 BEE RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-210-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty