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General NPI Number Information
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NPI Number | 1043585888
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTH ENTERPRISES, INC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 2820 GIBSON RD SUITE #A
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City | JACKSONVILLE
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State | FL
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Zip | 32207-4804
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Country | US
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Telephone | 904-503-2745
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Fax | 904-503-2746
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Provider Business Mailing Address
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Address Line | 2820 GIBSON RD SUITE #A
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City | JACKSONVILLE
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State | FL
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Zip | 32207-4804
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Country | US
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Telephone | 904-503-2745
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Fax | 904-503-2746
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Authorized Official
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Title or Position | CHIROPRACTIC SERVICES DIRECTOR
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Name | DR. CHRISTOPHER R BURNHAM
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Credential | D.C., B.S.
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Telephone | 904-503-2745
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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 | CH10080
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License Number State | FL
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