Provider Demographics
NPI:1639200967
Name:CHIROPRACTIC LONGEVITY & WELLNESS CENTER
Entity Type:Organization
Organization Name:CHIROPRACTIC LONGEVITY & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRUSING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-921-5786
Mailing Address - Street 1:4837 SWIFT RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SARASOTA FL
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5182
Mailing Address - Country:US
Mailing Address - Phone:941-921-5786
Mailing Address - Fax:941-921-5787
Practice Address - Street 1:4837 SWIFT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SARASOTA FL
Practice Address - State:FL
Practice Address - Zip Code:34231-5182
Practice Address - Country:US
Practice Address - Phone:941-921-5786
Practice Address - Fax:941-921-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 4015111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty