Healthcare Provider Details

I. General information

NPI: 1891412326
Provider Name (Legal Business Name): DR.JESUS CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 SAUTERNE DR
JACKSONVILLE FL
32210-7729
US

IV. Provider business mailing address

7785 POINT VICENTE CT
JACKSONVILLE FL
32256-7733
US

V. Phone/Fax

Practice location:
  • Phone: 904-999-9910
  • Fax:
Mailing address:
  • Phone: 787-564-0897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: LUIS JESUS RODRIGUEZ
Title or Position: MANAGER
Credential: DC
Phone: 787-564-0897