Provider Demographics
NPI:1396017331
Name:JAY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:JAY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KEENUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-675-6886
Mailing Address - Street 1:3927 HIGHWAY 4
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-1752
Mailing Address - Country:US
Mailing Address - Phone:850-675-6886
Mailing Address - Fax:850-675-6886
Practice Address - Street 1:5035 SAINTS LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4046
Practice Address - Country:US
Practice Address - Phone:850-748-0740
Practice Address - Fax:850-675-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0009285305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88206OtherBLUE CROSS BLUE SHIELD OF FLORIDA