Provider Demographics
NPI:1033942917
Name:HAWTHORNE, AMY (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7707 MERRILL RD UNIT 8730
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-7731
Mailing Address - Country:US
Mailing Address - Phone:628-888-5951
Mailing Address - Fax:
Practice Address - Street 1:5627 ATLANTIC BLVD STE 7
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2267
Practice Address - Country:US
Practice Address - Phone:904-206-7781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor