Provider Demographics
NPI:1407072242
Name:MUSA CHIROPRACTIC & WELLNESS CENTER INC
Entity Type:Organization
Organization Name:MUSA CHIROPRACTIC & WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-272-3440
Mailing Address - Street 1:1915 EAST WEST PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-6350
Mailing Address - Country:US
Mailing Address - Phone:904-269-1799
Mailing Address - Fax:904-269-0970
Practice Address - Street 1:1915 EAST WEST PKWY STE 1
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-6350
Practice Address - Country:US
Practice Address - Phone:904-269-1799
Practice Address - Fax:904-269-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH008125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3527Medicare PIN