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General NPI Number Information
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NPI Number | 1003126574
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Entity Type | Organization
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Legal Business Name | GSW CLINIC, LLC
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 3728 PHILLIPS HWY SUITE 13
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City | JACKSONVILLE
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State | FL
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Zip | 32207-9300
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Country | US
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Telephone | 904-477-4480
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Fax | 904-683-5619
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Provider Business Mailing Address
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Address Line | PO BOX 47125
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City | JACKSONVILLE
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State | FL
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Zip | 32247-7125
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Country | US
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Telephone | 904-477-4480
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Fax |
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Authorized Official
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Title or Position | PRIMARY MEMBER
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Name | GEORGE STEVEN WEBB
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Credential | M.D.
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Telephone | 904-477-4480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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