Venice Village Chiropractic Clinic PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH7387 Issued in FL

Legal business name

VENICE VILLAGE CHIROPRACTIC CLINIC PA

Practice address

4140 Woodmere Park Blvd
Ste 2
Venice, FL 34293-2205

Phone

(941) 497-7424

Fax

(941) 493-8413

NPI assigned

Aug 20, 2007

Last updated

Aug 20, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gary E Bolen, DCNPI 1467568816

Title

President Owner

Phone

(941) 497-7424

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary Eugene Bolen, DC

  • Chiropractor
  • Venice, FL
  • NPI 1467568816
  Medicare reassignment Care Compare group NPD Authorized official
• Tyler Andrew Moyer, D.C.

  • Chiropractor
  • Venice, FL
  • NPI 1609529056
  Medicare reassignment Care Compare group NPD
• Leigh Alicia Treco Sierra, D.C.

  • Chiropractor
  • Venice, FL
  • NPI 1639459852
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187568000000",
    "number": "1033302492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4140 WOODMERE PARK BLVD",
            "address_2": "STE 2",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342932205",
            "telephone_number": "941-497-7424",
            "fax_number": "941-493-8413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4140 WOODMERE PARK BLVD",
            "address_2": "STE 2",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342932205",
            "telephone_number": "941-497-7424",
            "fax_number": "941-493-8413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VENICE VILLAGE CHIROPRACTIC CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-20",
        "last_updated": "2007-08-20",
        "status": "A",
        "authorized_official_last_name": "BOLEN",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "941-497-7424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH7387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38112550",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Venice Rehab Center, LLC (AdviniaCare at Venice)
• Venice Rehab, LLC (FYZICAL Therapy and Balance Centers)
• Venice Retina, P.a.
• Venice SNF Opco LLC
• Venice Tuscan Operator, LLC (Tuscan Gardens of Venetia Bay)
• Venice Vision Center, Inc
• Venice Vision LLC
• Angelica Ventresca, LCSW
• Jenny Vest, APRN
• Michael Vicente

• Chiropractor in Venice, FL
• Providers in Venice, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.