Provider Demographics
NPI:1164688354
Name:LAND CHIROPRACTIC AND SPORTS CLINIC LLC
Entity Type:Organization
Organization Name:LAND CHIROPRACTIC AND SPORTS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-477-5057
Mailing Address - Street 1:8823 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4287
Mailing Address - Country:US
Mailing Address - Phone:904-338-9995
Mailing Address - Fax:
Practice Address - Street 1:8823 SAN JOSE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4287
Practice Address - Country:US
Practice Address - Phone:904-338-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty