MEDICARE: THE MOVEMENT COLLECTIVE 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	111NS0005X	Sports Physician Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215799614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MOVEMENT COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	5530-1 FLORIDA MINING BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5530-1 FLORIDA MINING BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257
Country	:	US
Telephone Number	:	252-945-7456
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/ DOCTOR OF CHIROPRACTIC
Name	:	DR. HANNAH HEIDENREICH
Credential	:	D.C.
Telephone Number	:	239-595-1453

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	01/30/2024

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Directions to “THE MOVEMENT COLLECTIVE LLC ” Practice Location

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