Healthcare Provider Details

I. General information

NPI: 1003330838
Provider Name (Legal Business Name): SARASOTA SPINE & SPORT CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5517 21ST AVE W STE F
BRADENTON FL
34209-5604
US

IV. Provider business mailing address

3900 CLARK RD STE H1
SARASOTA FL
34233-2366
US

V. Phone/Fax

Practice location:
  • Phone: 941-321-9002
  • Fax: 941-926-1166
Mailing address:
  • Phone: 941-926-1600
  • Fax: 941-926-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN A BERMAN
Title or Position: OWNER
Credential: DC
Phone: 941-926-1600