Healthcare Provider Details

I. General information

NPI: 1992398721
Provider Name (Legal Business Name): ANTHONY ISELBORN, DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 HENDRICKS AVE
JACKSONVILLE FL
32207-5301
US

IV. Provider business mailing address

3355 HENDRICKS AVE
JACKSONVILLE FL
32207-5301
US

V. Phone/Fax

Practice location:
  • Phone: 904-731-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY J ISELBORN
Title or Position: PRESIDENT
Credential: DC,ATC
Phone: 904-731-3000