Provider Demographics
NPI:1417235276
Name:RELYON CHIROPRACTIC AND REHAB INC
Entity Type:Organization
Organization Name:RELYON CHIROPRACTIC AND REHAB INC
Other - Org Name:RELYON MOBILE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:KINES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-849-3141
Mailing Address - Street 1:140 CALLE EL JARDIN
Mailing Address - Street 2:UNIT 201
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-6885
Mailing Address - Country:US
Mailing Address - Phone:904-849-3141
Mailing Address - Fax:
Practice Address - Street 1:140 CALLE EL JARDIN
Practice Address - Street 2:UNIT 201
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-6885
Practice Address - Country:US
Practice Address - Phone:904-849-3141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1590AMedicare PIN