Provider Demographics
NPI:1174861165
Name:SARASOTA SPINE & SPORT CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:SARASOTA SPINE & SPORT CHIROPRACTIC CLINIC
Other - Org Name:SARASOTA SPINE & JOINT INTEGRATED MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ALAN
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
Mailing Address - Street 2:H-1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2301
Mailing Address - Country:US
Mailing Address - Phone:941-926-1600
Mailing Address - Fax:941-926-1166
Practice Address - Street 1:3900 CLARK RD
Practice Address - Street 2:H-1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2301
Practice Address - Country:US
Practice Address - Phone:941-926-1600
Practice Address - Fax:941-926-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7276950001OtherDME
FLDU2456OtherRR MEDICARE
FLHA944AOtherMEDICARE