Provider Demographics
NPI:1083023204
Name:ST AUGUSTINE PHYSICIANS ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ST AUGUSTINE PHYSICIANS ASSOCIATES, INC.
Other - Org Name:MONAHAN CHIROPRACTIC MEDICAL CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MONAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-824-8353
Mailing Address - Street 1:905 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-4649
Mailing Address - Country:US
Mailing Address - Phone:386-328-2710
Mailing Address - Fax:386-328-9708
Practice Address - Street 1:905 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4649
Practice Address - Country:US
Practice Address - Phone:386-328-2710
Practice Address - Fax:386-328-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty