Provider Demographics
NPI:1164866950
Name:DYNAMIC HEALTH AND CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DYNAMIC HEALTH AND CHIROPRACTIC LLC
Other - Org Name:PIERCE CHIROPRACTIC & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THAOLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-724-5433
Mailing Address - Street 1:9424 BAYMEADOWS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7990
Mailing Address - Country:US
Mailing Address - Phone:904-724-5433
Mailing Address - Fax:904-724-9671
Practice Address - Street 1:9424 BAYMEADOWS RD STE 130
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7990
Practice Address - Country:US
Practice Address - Phone:904-724-5433
Practice Address - Fax:904-724-9671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty