Provider Demographics
NPI:1225543648
Name:BIOMECHANICS WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:BIOMECHANICS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BEKKERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-323-3870
Mailing Address - Street 1:2803 FRUITVILLE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-5367
Mailing Address - Country:US
Mailing Address - Phone:941-281-5451
Mailing Address - Fax:
Practice Address - Street 1:2803 FRUITVILLE RD STE 130
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5367
Practice Address - Country:US
Practice Address - Phone:941-281-5451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1578937405Medicaid
FL1598116741Medicaid
FL18513217Medicaid
FL1982803441Medicaid
FL1043734031Medicaid
FL1619906294Medicaid
FL1790012201Medicaid