MEDICARE: PRECISION SPINE HEALTH AND INJURY CARE, PA

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

General Provider Information

NPI Number	:	1235413543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION SPINE HEALTH AND INJURY CARE, PA

Provider Business Mailing Address
First Line	:	12620 BEACH BLVD STE 5
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7130
Country	:	US
Telephone Number	:	904-997-1717
Fax Number	:	904-645-3483

Provider Business Practice Location Address
First Line	:	12620 BEACH BLVD STE 5
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7130
Country	:	US
Telephone Number	:	904-997-1717
Fax Number	:	904-645-3483

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	DR. ALAN J BOUDREAU
Credential	:	D.C.
Telephone Number	:	904-591-3652

Provider Enumeration Date	:	10/05/2011
Last Update Date	:	10/05/2011

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