Provider Demographics
NPI:1982774931
Name:JACKSONVILLE CHIROPRACTIC ASSOCIATES, INC
Entity Type:Organization
Organization Name:JACKSONVILLE CHIROPRACTIC ASSOCIATES, INC
Other - Org Name:WELLSPRING HEALTH AND SPORTS PERFORMANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAMPFE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-249-1551
Mailing Address - Street 1:710 3RD ST. NORTH
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250
Mailing Address - Country:US
Mailing Address - Phone:904-249-1551
Mailing Address - Fax:904-249-1530
Practice Address - Street 1:710 3RD ST. NORTH
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-249-1551
Practice Address - Fax:904-249-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5569111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCS642AOtherPTAN