Provider Demographics
NPI:1912568643
Name:DANDRIDGE, JON (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:DANDRIDGE
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 1:116 BARTRAM OAKS WALK
Mailing Address - Street 2:STE 104
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3267
Mailing Address - Country:US
Mailing Address - Phone:904-446-5233
Mailing Address - Fax:
Practice Address - Street 1:116 BARTRAM OAKS WALK STE 104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-3267
Practice Address - Country:US
Practice Address - Phone:904-446-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor