Provider Demographics
NPI:1275838856
Name:DEMAIO CHIROPRACTIC WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:DEMAIO CHIROPRACTIC WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:WANDA
Authorized Official - Last Name:DEMAIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-504-1792
Mailing Address - Street 1:4002 CROCKERS LAKE BLVD
Mailing Address - Street 2:UNIT 124
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5502
Mailing Address - Country:US
Mailing Address - Phone:941-504-1792
Mailing Address - Fax:
Practice Address - Street 1:7101 CURTISS AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8012
Practice Address - Country:US
Practice Address - Phone:941-504-1792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty