Provider Demographics
NPI:1376883298
Name:CHANATRYDC, LLC
Entity Type:Organization
Organization Name:CHANATRYDC, LLC
Other - Org Name:CHANATRY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHANATRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-257-3767
Mailing Address - Street 1:2711 UNIVERSITY BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-3235
Mailing Address - Country:US
Mailing Address - Phone:904-743-6700
Mailing Address - Fax:904-743-9101
Practice Address - Street 1:2711 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3235
Practice Address - Country:US
Practice Address - Phone:904-743-6700
Practice Address - Fax:904-745-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10814111N00000X
111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1881932754OtherINDIVIDUAL NPI
FL1881932754OtherINDIVIDUAL NPI