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General NPI Number Information
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NPI Number | 1164894895
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Entity Type | Organization
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Legal Business Name | BEE RIDGE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 3400 BEE RIDGE RD STE 100
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City | SARASOTA
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State | FL
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Zip | 34239
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Country | US
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Telephone | 941-210-3637
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 BEE RIDGE RD STE 100
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City | SARASOTA
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State | FL
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Zip | 34239-7243
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Country | US
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Telephone | 941-210-3637
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | RHETT ETHAN BOGACZ
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Credential | DC
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Telephone | 941-210-3637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH11394
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License Number State | FL
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