Provider Demographics
NPI:1720497340
Name:HAVLICEK CHIROPRACTIC INC
Entity Type:Organization
Organization Name:HAVLICEK CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVLICEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-515-2225
Mailing Address - Street 1:2085 A1A S STE 103
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6505
Mailing Address - Country:US
Mailing Address - Phone:904-515-2225
Mailing Address - Fax:904-515-2235
Practice Address - Street 1:2085 A1A S STE 103
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6505
Practice Address - Country:US
Practice Address - Phone:904-522-2515
Practice Address - Fax:904-515-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty