Provider Demographics
NPI:1629387832
Name:J. DAVID SHORE, P.A.
Entity Type:Organization
Organization Name:J. DAVID SHORE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-733-8833
Mailing Address - Street 1:2431 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2037
Mailing Address - Country:US
Mailing Address - Phone:904-733-8833
Mailing Address - Fax:904-733-3617
Practice Address - Street 1:2431 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2037
Practice Address - Country:US
Practice Address - Phone:904-733-8833
Practice Address - Fax:904-733-3617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70864Medicare PIN
FLT84540Medicare UPIN