Provider Demographics
NPI:1073740189
Name:SAMBURSKY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SAMBURSKY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMBURSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-683-4376
Mailing Address - Street 1:12412 SAN JOSE BLVD
Mailing Address - Street 2:203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8621
Mailing Address - Country:US
Mailing Address - Phone:904-683-4376
Mailing Address - Fax:
Practice Address - Street 1:12412 SAN JOSE BLVD
Practice Address - Street 2:203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8621
Practice Address - Country:US
Practice Address - Phone:904-683-4376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty