Provider Demographics
NPI:1376505156
Name:SOUTHEASTERN HEALTHCARE OF JACKSONVILLE
Entity Type:Organization
Organization Name:SOUTHEASTERN HEALTHCARE OF JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-392-1488
Mailing Address - Street 1:260 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6332
Mailing Address - Country:US
Mailing Address - Phone:910-355-6000
Mailing Address - Fax:910-355-7533
Practice Address - Street 1:260 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6332
Practice Address - Country:US
Practice Address - Phone:910-355-6000
Practice Address - Fax:910-355-7533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty