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General NPI Number Information
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NPI Number | 1023323441
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Entity Type | Organization
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Legal Business Name | DR. DOCTOR D.I.S.C. CLINIC P. A.
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 115 W 8TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32206-3657
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Country | US
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Telephone | 904-350-3737
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Fax | 904-358-7749
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Provider Business Mailing Address
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Address Line | 115 W 8TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32206-3657
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Country | US
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Telephone | 904-350-3737
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Fax | 904-358-7749
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Authorized Official
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Title or Position | CEO/CHIROPRACTOR
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Name | DR. ZEBOYE ARCHELL DOCTOR
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Credential | D.C.
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Telephone | 904-350-3737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | CH9349
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License Number State | FL
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