Provider Demographics
NPI:1629594866
Name:JM. JZ ENTERPRISES
Entity Type:Organization
Organization Name:JM. JZ ENTERPRISES
Other - Org Name:REVITASPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-602-2888
Mailing Address - Street 1:8439 E GARDEN OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6369
Mailing Address - Country:US
Mailing Address - Phone:561-768-5699
Mailing Address - Fax:561-803-8708
Practice Address - Street 1:210 JUPITER LAKES BLVD STE 5205
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-633-4142
Practice Address - Fax:561-803-8708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9815261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center