Provider Demographics
NPI:1467678284
Name:ACCIDENT CARE CHIROPRACTIC & HOLISTIC MEDICINE, INC.
Entity Type:Organization
Organization Name:ACCIDENT CARE CHIROPRACTIC & HOLISTIC MEDICINE, 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 1:1205 MONUMENT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7406
Mailing Address - Country:US
Mailing Address - Phone:904-725-6007
Mailing Address - Fax:904-725-6009
Practice Address - Street 1:1205 MONUMENT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7406
Practice Address - Country:US
Practice Address - Phone:904-725-6007
Practice Address - Fax:904-725-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22240Medicare PIN