Provider Demographics
NPI:1639542384
Name:PROACTIVE HEALTH OF MANDARIN LLC
Entity Type:Organization
Organization Name:PROACTIVE HEALTH OF MANDARIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:DEANN
Authorized Official - Last Name:SWANSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-704-3683
Mailing Address - Street 1:12428 SAN JOSE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8617
Mailing Address - Country:US
Mailing Address - Phone:904-704-3683
Mailing Address - Fax:904-288-8995
Practice Address - Street 1:12428 SAN JOSE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8617
Practice Address - Country:US
Practice Address - Phone:904-704-3683
Practice Address - Fax:904-288-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11696261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service