Provider Demographics
NPI:1023323441
Name:DR. DOCTOR D.I.S.C. CLINIC P. A.
Entity type:Organization
Organization Name:DR. DOCTOR D.I.S.C. CLINIC P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZEBOYE
Authorized Official - Middle Name:ARCHELL
Authorized Official - Last Name:DOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-350-3737
Mailing Address - Street 1:115 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-3657
Mailing Address - Country:US
Mailing Address - Phone:904-350-3737
Mailing Address - Fax:904-358-7749
Practice Address - Street 1:115 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-3657
Practice Address - Country:US
Practice Address - Phone:904-350-3737
Practice Address - Fax:904-358-7749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9349302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization