Provider Demographics
NPI:1053595066
Name:MANATEE WELLNESS CENTER, INC
Entity type:Organization
Organization Name:MANATEE WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLAIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-756-4362
Mailing Address - Street 1:2411 57TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-3260
Mailing Address - Country:US
Mailing Address - Phone:941-756-4362
Mailing Address - Fax:941-755-4652
Practice Address - Street 1:2411 57TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-3260
Practice Address - Country:US
Practice Address - Phone:941-756-4362
Practice Address - Fax:941-755-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T78984Medicare UPIN