MEDICARE: SIMPLE RELIEF HEALTH & WELLNESS 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	CH7535	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74909	OTHER	FL	BCBS GROUP NUMBER
2	CH7535	OTHER	FL	FLORIDA MEDICAL LICENSE

General Provider Information

NPI Number	:	1871610444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLE RELIEF HEALTH & WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	625 N WASHINGTON BLVD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-4241
Country	:	US
Telephone Number	:	941-363-9000
Fax Number	:	941-951-1808

Provider Business Practice Location Address
First Line	:	625 N WASHINGTON BLVD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-4241
Country	:	US
Telephone Number	:	941-363-9000
Fax Number	:	941-951-1808

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER, PHYSICIAN
Name	:	DR. JOSEPH SCOTT BALEN
Credential	:	DC, ND
Telephone Number	:	941-363-9000

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/22/2020

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