Provider Demographics
NPI:1841695236
Name:VENICE HEALTH AND WELLNESS
Entity type:Organization
Organization Name:VENICE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:BARBERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-497-7400
Mailing Address - Street 1:114 SHAMROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1629
Mailing Address - Country:US
Mailing Address - Phone:941-497-7400
Mailing Address - Fax:813-342-7926
Practice Address - Street 1:114 SHAMROCK BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1629
Practice Address - Country:US
Practice Address - Phone:941-497-7400
Practice Address - Fax:813-342-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFW917AMedicare PIN