Provider Demographics
NPI:1689798019
Name:JST CHIROPRACTIC INC
Entity Type:Organization
Organization Name:JST CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:SEYLER
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-867-1200
Mailing Address - Street 1:2929 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-7032
Mailing Address - Country:US
Mailing Address - Phone:352-867-1200
Mailing Address - Fax:352-867-1400
Practice Address - Street 1:2929 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-7032
Practice Address - Country:US
Practice Address - Phone:352-867-1200
Practice Address - Fax:352-867-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL76971OtherBLUE CROSS BLUE SHIELD
FL1114950037OtherPERSONAL NPI
FL381622200Medicaid
FL381622200Medicaid