Provider Demographics
NPI:1407097546
Name:BEE RIDGE CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:BEE RIDGE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-365-8555
Mailing Address - Street 1:PO BOX 21962
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34276-4962
Mailing Address - Country:US
Mailing Address - Phone:941-365-8555
Mailing Address - Fax:941-756-8744
Practice Address - Street 1:6155 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4404
Practice Address - Country:US
Practice Address - Phone:941-753-3949
Practice Address - Fax:941-756-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70249OtherBLUE CROSS PROVIDER #
FL381785700Medicaid
FLK2568OtherMEDICARE GROUP #
FL381785700Medicaid
FLK2568OtherMEDICARE GROUP #