Healthcare Provider Details

I. General information

NPI: 1457977449
Provider Name (Legal Business Name): GAINESVILLE BACK AND NECK PAIN RELIEF CHIROPRACTIC,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 NW 23RD AVE STE 6
GAINESVILLE FL
32606-6570
US

IV. Provider business mailing address

4509 NW 23RD AVE STE 6
GAINESVILLE FL
32606-6570
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-5158
  • Fax: 888-871-3404
Mailing address:
  • Phone: 352-377-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: SHANNON WILMOT BARGER
Title or Position: OWNER
Credential: DC
Phone: 513-317-8698