Healthcare Provider Details

I. General information

NPI: 1841071602
Provider Name (Legal Business Name): ST JOHNS MEDICAL LLC DBA AMAZING SPINE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W TOWN PL STE 104-106
ST AUGUSTINE FL
32092-3661
US

IV. Provider business mailing address

425 W TOWN PL STE 104-106
ST AUGUSTINE FL
32092-3661
US

V. Phone/Fax

Practice location:
  • Phone: 904-701-3916
  • Fax:
Mailing address:
  • Phone: 904-701-3916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN KHIGER
Title or Position: AUTHORIZED OFFICIAL
Credential: CHIROPRACTOR
Phone: 347-755-4956