Provider Demographics
NPI:1124209804
Name:HOWARD ACCIDENT & INJURY CHIROPRACTI CLINIC PA
Entity Type:Organization
Organization Name:HOWARD ACCIDENT & INJURY CHIROPRACTI CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-725-8111
Mailing Address - Street 1:6929 BEACH BLVD
Mailing Address - Street 2:STE. 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2822
Mailing Address - Country:US
Mailing Address - Phone:904-725-8111
Mailing Address - Fax:904-725-8297
Practice Address - Street 1:6929 BEACH BLVD
Practice Address - Street 2:STE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2822
Practice Address - Country:US
Practice Address - Phone:904-725-8111
Practice Address - Fax:904-725-8297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050961200Medicaid
FLK3852Medicare UPIN