Provider Demographics
NPI:1255738084
Name:NATURALLY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:NATURALLY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUTCHEON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-625-5714
Mailing Address - Street 1:12627 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2662
Mailing Address - Country:US
Mailing Address - Phone:904-683-9698
Mailing Address - Fax:904-683-3941
Practice Address - Street 1:12627 SAN JOSE BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2662
Practice Address - Country:US
Practice Address - Phone:904-683-9698
Practice Address - Fax:904-683-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty