Provider Demographics
NPI:1477604593
Name:ACCIDENT CARE AND WELLNESS CHIROPRACTIC CLINIC SAN JOSE
Entity Type:Organization
Organization Name:ACCIDENT CARE AND WELLNESS CHIROPRACTIC CLINIC SAN JOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:STEVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-737-1111
Mailing Address - Street 1:9315 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5503
Mailing Address - Country:US
Mailing Address - Phone:904-737-1111
Mailing Address - Fax:904-737-1116
Practice Address - Street 1:9315 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5503
Practice Address - Country:US
Practice Address - Phone:904-737-1111
Practice Address - Fax:904-737-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty