Provider Demographics
NPI:1740812668
Name:HEALING ROOTS CHIROPRACTIC CENTERS LLC
Entity type:Organization
Organization Name:HEALING ROOTS CHIROPRACTIC CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:DANDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-446-5233
Mailing Address - Street 1:116 BARTRAM OAKS WALK STE 104
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3267
Mailing Address - Country:US
Mailing Address - Phone:904-701-0099
Mailing Address - Fax:
Practice Address - Street 1:116 BARTRAM OAKS WALK STE 104
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3267
Practice Address - Country:US
Practice Address - Phone:904-701-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty