Provider Demographics
NPI:1831554500
Name:CHIROPRACTIC SPINE & INJURY CENTER
Entity type:Organization
Organization Name:CHIROPRACTIC SPINE & INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-325-8305
Mailing Address - Street 1:784 BLANDING BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065
Mailing Address - Country:US
Mailing Address - Phone:904-276-7002
Mailing Address - Fax:
Practice Address - Street 1:784 BLANDING BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065
Practice Address - Country:US
Practice Address - Phone:904-276-7002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty