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General NPI Number Information
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NPI Number | 1306229950
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Entity Type | Organization
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Legal Business Name | MAINSTAY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 717 HONORE AVE
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City | SARASOTA
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State | FL
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Zip | 34232-2761
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Country | US
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Telephone | 941-342-1291
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Fax |
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Provider Business Mailing Address
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Address Line | 717 HONORE AVE
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City | SARASOTA
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State | FL
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Zip | 34232-2761
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Country | US
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Telephone | 941-342-1291
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BEAU RYAN SMITH
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Credential | D.C.
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Telephone | 941-342-1291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | CH11307
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License Number State | FL
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