Provider Demographics
NPI:1750811477
Name:GAINER, JUDITH SHAE (DC)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:SHAE
Last Name:GAINER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 CORACI BLVD APT 4302
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7574
Mailing Address - Country:US
Mailing Address - Phone:304-991-1303
Mailing Address - Fax:
Practice Address - Street 1:1184 PELICAN BAY DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1381
Practice Address - Country:US
Practice Address - Phone:386-453-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor