Provider Demographics
NPI:1023347093
Name:JACKSONVILLE CHIROPRACTIC & ACUPUNCTURE LLC
Entity type:Organization
Organization Name:JACKSONVILLE CHIROPRACTIC & ACUPUNCTURE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-382-6763
Mailing Address - Street 1:13770 BEACH BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7227
Mailing Address - Country:US
Mailing Address - Phone:904-619-2703
Mailing Address - Fax:904-619-2837
Practice Address - Street 1:13770 BEACH BLVD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7227
Practice Address - Country:US
Practice Address - Phone:904-619-2703
Practice Address - Fax:904-619-2837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9264111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty