Provider Demographics
NPI:1366874661
Name:MICHAEL J. PAULK P.A.
Entity type:Organization
Organization Name:MICHAEL J. PAULK P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACITC PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PAULK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-264-3966
Mailing Address - Street 1:1413 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4527
Mailing Address - Country:US
Mailing Address - Phone:904-264-3966
Mailing Address - Fax:904-278-7171
Practice Address - Street 1:1413 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4527
Practice Address - Country:US
Practice Address - Phone:904-264-3966
Practice Address - Fax:904-278-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty