Provider Demographics
NPI:1619241890
Name:BEACH BOULEVARD CHIROPRACTIC
Entity Type:Organization
Organization Name:BEACH BOULEVARD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR / MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-801-4465
Mailing Address - Street 1:11915 BEACH BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-6704
Mailing Address - Country:US
Mailing Address - Phone:904-683-0793
Mailing Address - Fax:904-619-4740
Practice Address - Street 1:11915 BEACH BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6704
Practice Address - Country:US
Practice Address - Phone:904-683-0793
Practice Address - Fax:904-619-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty