Provider Demographics
NPI:1295108561
Name:DR J COMERFORD PA
Entity type:Organization
Organization Name:DR J COMERFORD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SCOT
Authorized Official - Last Name:COMERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-586-7145
Mailing Address - Street 1:280 CORPORATE WAY SE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-3803
Mailing Address - Country:US
Mailing Address - Phone:321-586-7145
Mailing Address - Fax:
Practice Address - Street 1:280 CORPORATE WAY SE
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-3803
Practice Address - Country:US
Practice Address - Phone:321-586-7145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-08
Last Update Date:2015-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9891111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty