Healthcare Provider Details

I. General information

NPI: 1144538349
Provider Name (Legal Business Name): OAKLEAF FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9785 CROSSHILL BLVD STE 108
JACKSONVILLE FL
32222-5823
US

IV. Provider business mailing address

9785 CROSSHILL BLVD STE 108
JACKSONVILLE FL
32222-5823
US

V. Phone/Fax

Practice location:
  • Phone: 904-772-6522
  • Fax: 904-772-6553
Mailing address:
  • Phone: 904-772-6522
  • Fax: 904-772-6553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: NATALIE THOMPSON
Title or Position: OWNER
Credential:
Phone: 904-772-6522