Provider Demographics
NPI:1508537234
Name:DR DOCTOR DISC INJURY AND SPINAL CARE CLINIC PA
Entity Type:Organization
Organization Name:DR DOCTOR DISC INJURY AND SPINAL CARE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ZEBOYE
Authorized Official - Middle Name:ARCHELLQ
Authorized Official - Last Name:DOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-350-3737
Mailing Address - Street 1:115 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-3657
Mailing Address - Country:US
Mailing Address - Phone:904-350-3737
Mailing Address - Fax:844-373-7329
Practice Address - Street 1:115 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-3657
Practice Address - Country:US
Practice Address - Phone:904-350-3737
Practice Address - Fax:844-373-7329
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR DOCTOR DISC INJURY AND SPINCAL CARE CLINIC PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-22
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty