Healthcare Provider Details

I. General information

NPI: 1285757526
Provider Name (Legal Business Name): JLSOLANA JR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 EDGEWOOD AVE N SUITE 18
JACKSONVILLE FL
32254-1400
US

IV. Provider business mailing address

2851 EDGEWOOD AVE N SUITE 18
JACKSONVILLE FL
32254-1400
US

V. Phone/Fax

Practice location:
  • Phone: 904-359-5464
  • Fax: 904-359-5460
Mailing address:
  • Phone: 904-359-5464
  • Fax: 904-359-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR006734
License Number StateGA

VIII. Authorized Official

Name: DR. JAMES LOUIS SOLANA JR.
Title or Position: PRESIDENT
Credential: D.C.
Phone: 904-359-5464