Provider Demographics
NPI:1952640823
Name:BAIN DE VIE RIVERVIEW LLC
Entity Type:Organization
Organization Name:BAIN DE VIE RIVERVIEW LLC
Other - Org Name:BAIN COMPLETE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-907-9898
Mailing Address - Street 1:10323 CROSS CREEK BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2988
Mailing Address - Country:US
Mailing Address - Phone:813-907-9898
Mailing Address - Fax:
Practice Address - Street 1:13021 SUMMERFIELD SQUARE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7402
Practice Address - Country:US
Practice Address - Phone:813-907-9898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty