Provider Demographics
NPI:1851587323
Name:FT CAROLINE CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:FT CAROLINE CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SESSIONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-564-2500
Mailing Address - Street 1:12086 FORT CAROLINE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-2687
Mailing Address - Country:US
Mailing Address - Phone:904-564-2500
Mailing Address - Fax:904-564-2566
Practice Address - Street 1:12086 FORT CAROLINE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-2687
Practice Address - Country:US
Practice Address - Phone:904-564-2500
Practice Address - Fax:904-564-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6878Medicare PIN