Provider Demographics
NPI:1104860139
Name:HUNTER, MICHAEL BRENT (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRENT
Last Name:HUNTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2713
Mailing Address - Country:US
Mailing Address - Phone:904-217-8148
Mailing Address - Fax:
Practice Address - Street 1:4211 N PEARL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-6411
Practice Address - Country:US
Practice Address - Phone:904-358-8692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3352111N00000X
FLCH 9572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHQ417AOtherMEDICARE PTAN
OH2374443Medicaid
FLHQ417AOtherMEDICARE PTAN
HU4098591Medicare ID - Type Unspecified