Provider Demographics
NPI:1013733146
Name:AMPLIFIED CHIROPRACTIC AND WELLNES
Entity type:Organization
Organization Name:AMPLIFIED CHIROPRACTIC AND WELLNES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-201-0206
Mailing Address - Street 1:1201 JACARANDA BLVD STE 1203
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4535
Mailing Address - Country:US
Mailing Address - Phone:941-201-0206
Mailing Address - Fax:
Practice Address - Street 1:1201 JACARANDA BLVD STE 1203
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4535
Practice Address - Country:US
Practice Address - Phone:941-201-0206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty