Provider Demographics
NPI:1639470339
Name:RICE CHIROPRACTIC CARE, INC.
Entity Type:Organization
Organization Name:RICE CHIROPRACTIC CARE, INC.
Other - Org Name:BIRD BAY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-484-0940
Mailing Address - Street 1:1435 E VENICE AVE UNIT 107
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3074
Mailing Address - Country:US
Mailing Address - Phone:941-484-0940
Mailing Address - Fax:
Practice Address - Street 1:1435 E VENICE AVE UNIT 107
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3074
Practice Address - Country:US
Practice Address - Phone:941-484-0940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381035600Medicaid
55560AMedicare PIN
FL381035600Medicaid