Provider Demographics
NPI:1811292436
Name:CLEARWATER SPORTS & WELLNESS PA
Entity type:Organization
Organization Name:CLEARWATER SPORTS & WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:SESSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-669-3900
Mailing Address - Street 1:2555 ENTERPRISE RD
Mailing Address - Street 2:STE 5
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1104
Mailing Address - Country:US
Mailing Address - Phone:727-669-3900
Mailing Address - Fax:727-669-3998
Practice Address - Street 1:2555 ENTERPRISE RD
Practice Address - Street 2:STE 5
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1104
Practice Address - Country:US
Practice Address - Phone:727-669-3900
Practice Address - Fax:727-669-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty