Provider Demographics
NPI:1336541077
Name:MEAD, AUSTIN MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:MICHAEL
Last Name:MEAD
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 1:13453 N MAIN ST STE 501
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-2774
Mailing Address - Country:US
Mailing Address - Phone:904-783-0008
Mailing Address - Fax:904-783-0508
Practice Address - Street 1:13453 N MAIN ST STE 501
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2774
Practice Address - Country:US
Practice Address - Phone:904-783-0008
Practice Address - Fax:904-783-0508
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor