MEDICARE: GAVIN JAMES MCCUTCHEON D.C.

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	CH 10215	FL

General Provider Information

NPI Number	:	1427355247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAVIN JAMES MCCUTCHEON D.C.

Provider Business Mailing Address
First Line	:	12627 SAN JOSE BLVD
Second Line	:	STE 106
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8637
Country	:	US
Telephone Number	:	904-683-9698
Fax Number	:	904-683-3941

Provider Business Practice Location Address
First Line	:	4401 EMERSON ST
Second Line	:	SUITE 1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-4962
Country	:	US
Telephone Number	:	904-399-8884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	05/08/2019

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