MEDICARE: BLUE WATERS HEALTH CENTER, LLC

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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1205779113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE WATERS HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	3333 CLARK RD STE 160
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-8436
Country	:	US
Telephone Number	:	941-924-1057
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 CLARK RD STE 160
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-8436
Country	:	US
Telephone Number	:	941-924-1057
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL PATTEN
Credential	:	DC
Telephone Number	:	941-924-1057

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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