Healthcare Provider Details

I. General information

NPI: 1942878327
Provider Name (Legal Business Name): LAMOUNETTE CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6671 HYDE GROVE AVE
JACKSONVILLE FL
32210-2839
US

IV. Provider business mailing address

6671 HYDE GROVE AVE
JACKSONVILLE FL
32210-2839
US

V. Phone/Fax

Practice location:
  • Phone: 904-783-3700
  • Fax: 904-562-3314
Mailing address:
  • Phone: 904-783-3700
  • Fax: 904-562-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ROBERT G LAMOUNETTE
Title or Position: OWNER
Credential: DC
Phone: 904-783-3700