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General NPI Number Information
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NPI Number | 1053558692
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Entity Type | Individual
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Provider Name | LINDSEY KYLE JEUDEVINE D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/20/2009
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 208 S ALCANIZ ST
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City | PENSACOLA
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State | FL
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Zip | 32502-6012
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Country | US
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Telephone | 850-607-2105
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Fax | 850-607-6498
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Provider Business Mailing Address
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Address Line | 3461 GOLDENWOOD WAY
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City | PENSACOLA
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State | FL
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Zip | 32504-4916
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Country | US
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Telephone | 850-516-9155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH 9655
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License Number State | FL
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