Healthcare Provider Details

I. General information

NPI: 1821922857
Provider Name (Legal Business Name): INNOVATIVE CHIROPRACTIC CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TAMIAMI TRL S STE 150
VENICE FL
34285-2623
US

IV. Provider business mailing address

2510 ORSOVA WAY
SARASOTA FL
34231-4934
US

V. Phone/Fax

Practice location:
  • Phone: 203-868-5129
  • Fax:
Mailing address:
  • Phone: 203-868-5129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MARK CARRANO
Title or Position: OWNER
Credential:
Phone: 203-868-5129