Healthcare Provider Details

I. General information

NPI: 1700964012
Provider Name (Legal Business Name): CASTELLI CHIROPRACTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12187 BEACH BLVD STE 1
JACKSONVILLE FL
32246-0620
US

IV. Provider business mailing address

12187 BEACH BLVD STE 1
JACKSONVILLE FL
32246-0620
US

V. Phone/Fax

Practice location:
  • Phone: 904-854-9353
  • Fax: 904-212-2727
Mailing address:
  • Phone: 904-854-9353
  • Fax: 904-212-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: SEBASTIAN THOMAS CASTELLI
Title or Position: MGR
Credential:
Phone: 904-854-9353