MEDICARE: SARASOTA SPINE & SPORT CHIROPRACTIC CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	207R00000X	Internal Medicine Physician		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7276950002	OTHER	FL	DME

General Provider Information

NPI Number	:	1003330838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARASOTA SPINE & SPORT CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	3900 CLARK RD STE H1
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-2366
Country	:	US
Telephone Number	:	941-926-1600
Fax Number	:	941-926-1166

Provider Business Practice Location Address
First Line	:	5517 21ST AVE W STE F
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-5604
Country	:	US
Telephone Number	:	941-321-9002
Fax Number	:	941-926-1166

Authorized Official
Title or Position	:	OWNER
Name	:	JONATHAN A BERMAN
Credential	:	DC
Telephone Number	:	941-926-1600

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	04/11/2024

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