Provider Demographics
NPI:1841071602
Name:ST JOHNS MEDICAL LLC DBA AMAZING SPINE CARE
Entity type:Organization
Organization Name:ST JOHNS MEDICAL LLC DBA AMAZING SPINE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHIGER
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:347-755-4956
Mailing Address - Street 1:425 W TOWN PL STE 104-106
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3661
Mailing Address - Country:US
Mailing Address - Phone:904-701-3916
Mailing Address - Fax:
Practice Address - Street 1:425 W TOWN PL STE 104-106
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3661
Practice Address - Country:US
Practice Address - Phone:904-701-3916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty