MEDICARE: WHOLISTIC HEALTH CLINIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302F00000X	Exclusive Provider Organization	CH4392	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GF656A	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1376834549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLISTIC HEALTH CLINIC, INC

Provider Business Mailing Address
First Line	:	2196 GULF GATE DR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-4813
Country	:	US
Telephone Number	:	941-924-1413
Fax Number	:	941-923-3718

Provider Business Practice Location Address
First Line	:	2196 GULF GATE DR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-4813
Country	:	US
Telephone Number	:	941-924-1413
Fax Number	:	941-923-3718

Authorized Official
Title or Position	:	OWNER
Name	:	ALAN J LINKOFF
Credential	:	DC
Telephone Number	:	941-924-1413

Provider Enumeration Date	:	04/22/2011
Last Update Date	:	08/06/2012

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Directions to “WHOLISTIC HEALTH CLINIC, INC ” Practice Location

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