Healthcare Provider Details

I. General information

NPI: 1437364320
Provider Name (Legal Business Name): 210 FAMILY CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 HAMPTON POINT DR SUITE 4
SAINT AUGUSTINE FL
32092-3059
US

IV. Provider business mailing address

163 HAMPTON POINT DR SUITE 4
SAINT AUGUSTINE FL
32092-3059
US

V. Phone/Fax

Practice location:
  • Phone: 904-230-2717
  • Fax: 904-230-2720
Mailing address:
  • Phone: 904-230-2717
  • Fax: 904-230-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AGOSTINHO M OLIVEIRA
Title or Position: OWNER
Credential: DC
Phone: 904-230-2717