Healthcare Provider Details

I. General information

NPI: 1922383041
Provider Name (Legal Business Name): MCDONALD CHIROPRACTIC & ACUPUNCTURE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 TUSCAN WAY SUITE 103
ST AUGUSTINE FL
32092-1851
US

IV. Provider business mailing address

124 TUSCAN WAY SUITE 103
ST AUGUSTINE FL
32092-1851
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-9813
  • Fax: 904-940-1812
Mailing address:
  • Phone: 904-940-9813
  • Fax: 904-940-1812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10403
License Number StateFL

VIII. Authorized Official

Name: DR. TRACY ELIZABETH MCDONALD
Title or Position: OWNER
Credential: D.C.
Phone: 904-940-9813