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General NPI Number Information
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NPI Number | 1457654105
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Entity Type | Organization
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Legal Business Name | ISLAND HEALTHCARE INC.
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Dates
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Enumeration Date | 12/17/2010
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 4450 S TAMIAMI TRL
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City | SARASOTA
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State | FL
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Zip | 34231-3454
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Country | US
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Telephone | 941-927-7009
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Fax | 941-929-9715
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Provider Business Mailing Address
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Address Line | 4450 S TAMIAMI TRL
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City | SARASOTA
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State | FL
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Zip | 34231-3454
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Country | US
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Telephone | 941-927-7009
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Fax | 941-929-9715
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MARK ROBERT D'AMATO
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Credential | D.C.
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Telephone | 941-927-7009
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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 | CH 4427
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License Number State | FL
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