Provider Demographics
NPI:1275104697
Name:MEDINA, EKATERINA (DC)
Entity Type:Individual
Prefix:DR
First Name:EKATERINA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PITTMAN PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-4838
Mailing Address - Country:US
Mailing Address - Phone:386-237-5890
Mailing Address - Fax:
Practice Address - Street 1:14866 OLD SAINT AUGUSTINE RD STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2611
Practice Address - Country:US
Practice Address - Phone:904-348-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor