Provider Demographics
NPI:1295228039
Name:DME DC PROVIDER LLC
Entity Type:Organization
Organization Name:DME DC PROVIDER LLC
Other - Org Name:MEDICAL BRACING SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-477-6644
Mailing Address - Street 1:848 BUCKEYE LN W
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4387
Mailing Address - Country:US
Mailing Address - Phone:904-477-6644
Mailing Address - Fax:
Practice Address - Street 1:12641 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2646
Practice Address - Country:US
Practice Address - Phone:904-606-6007
Practice Address - Fax:904-376-8738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty