Healthcare Provider Details

I. General information

NPI: 1992202675
Provider Name (Legal Business Name): OAKLEAF CHIROPRACTIC AND INJURY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9785 CROSSHILL BLVD STE 108
JACKSONVILLE FL
32222-5823
US

IV. Provider business mailing address

9785 CROSSHILL BLVD STE 108
JACKSONVILLE FL
32222-5823
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-2437
  • Fax:
Mailing address:
  • Phone: 904-269-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIRESH SUBHASH PATEL
Title or Position: CEO
Credential:
Phone: 904-269-2437