Healthcare Provider Details

I. General information

NPI: 1881996759
Provider Name (Legal Business Name): DIGITAL MOTION X-RAY OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4617 BRENTWOOD AVE
JACKSONVILLE FL
32206-6168
US

IV. Provider business mailing address

PO BOX 17809
JACKSONVILLE FL
32245-7809
US

V. Phone/Fax

Practice location:
  • Phone: 904-350-5544
  • Fax: 904-350-9944
Mailing address:
  • Phone: 904-723-5665
  • Fax: 904-338-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberCH8235
License Number StateFL

VIII. Authorized Official

Name: DR. ROYCE MCGOWAN
Title or Position: PRESIDENT
Credential: DC
Phone: 904-350-5544