Provider Demographics
NPI:1407040868
Name:AFFORDABLE CHIROPRACTIC MEDICINE JACKSONVILLE LLC
Entity Type:Organization
Organization Name:AFFORDABLE CHIROPRACTIC MEDICINE JACKSONVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R.G.
Authorized Official - Middle Name:
Authorized Official - Last Name:PACKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-285-2243
Mailing Address - Street 1:3546 SAINT JOHNS BLUFF RD S UNIT 204
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2716
Mailing Address - Country:US
Mailing Address - Phone:904-996-2243
Mailing Address - Fax:904-997-2243
Practice Address - Street 1:3546 SAINT JOHNS BLUFF RD S UNIT 204
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2716
Practice Address - Country:US
Practice Address - Phone:904-996-2243
Practice Address - Fax:904-997-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty