Healthcare Provider Details

I. General information

NPI: 1639200967
Provider Name (Legal Business Name): CHIROPRACTIC LONGEVITY & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4837 SWIFT RD SUITE 202
SARASOTA FL FL
34231-5182
US

IV. Provider business mailing address

4837 SWIFT RD SUITE 202
SARASOTA FL FL
34231-5182
US

V. Phone/Fax

Practice location:
  • Phone: 941-921-5786
  • Fax: 941-921-5787
Mailing address:
  • Phone: 941-921-5786
  • Fax: 941-921-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH 4015
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 4015
License Number StateFL

VIII. Authorized Official

Name: DR. DAVID L. KRUSING
Title or Position: PRESIDENT
Credential: D.C.
Phone: 941-921-5786