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General NPI Number Information
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NPI Number | 1104305846
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Entity Type | Organization
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Legal Business Name | RISE CHIROPRACTIC AND ACUPUNCTURE LLC
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 14815 MANDARIN RD STE 103
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City | JACKSONVILLE
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State | FL
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Zip | 32223-2626
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Country | US
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Telephone | 937-623-1906
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Fax |
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Provider Business Mailing Address
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Address Line | 14815 MANDARIN RD STE 103
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City | JACKSONVILLE
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State | FL
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Zip | 32223-2626
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Country | US
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Telephone | 904-512-7449
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Fax | 904-764-8342
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DAVID J KLOSTERMAN
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Credential | DC
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Telephone | 937-623-1906
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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 | CH12491
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License Number State | FL
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