MEDICARE: RISE CHIROPRACTIC AND ACUPUNCTURE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH12491	FL

General Provider Information

NPI Number	:	1104305846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE CHIROPRACTIC AND ACUPUNCTURE LLC

Provider Business Mailing Address
First Line	:	14815 MANDARIN RD STE 103
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-2608
Country	:	US
Telephone Number	:	904-512-7449
Fax Number	:	904-764-8342

Provider Business Practice Location Address
First Line	:	14815 MANDARIN RD STE 103
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-2626
Country	:	US
Telephone Number	:	937-623-1906
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	DAVID J KLOSTERMAN
Credential	:	DC
Telephone Number	:	937-623-1906

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	02/20/2026

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