Provider Demographics
NPI:1710956669
Name:DEWEESE, DAMON CHRISTOPHER (DC)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:CHRISTOPHER
Last Name:DEWEESE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4836
Mailing Address - Country:US
Mailing Address - Phone:904-757-4786
Mailing Address - Fax:904-757-4882
Practice Address - Street 1:1312 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4836
Practice Address - Country:US
Practice Address - Phone:904-757-4786
Practice Address - Fax:904-757-4882
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00001614OtherRAILROAD MEDICARE
FLP00001614OtherRAILROAD MEDICARE
FL70562Medicare ID - Type UnspecifiedMEDICARE