Healthcare Provider Details

I. General information

NPI: 1184421745
Provider Name (Legal Business Name): BRYCE MICHAEL MRAKOVICH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 HENDRICKS AVE
JACKSONVILLE FL
32207-5301
US

IV. Provider business mailing address

57 PAMPLONA DR
ST AUGUSTINE FL
32086-0418
US

V. Phone/Fax

Practice location:
  • Phone: 904-731-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: