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General NPI Number Information
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NPI Number | 1114061546
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Entity Type | Organization
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Legal Business Name | SOUTH MANDARIN CHIROPRACTIC & WELLNESS
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Dates
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Enumeration Date | 02/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12058 SAN JOSE BLVD STE 301
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City | JACKSONVILLE
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State | FL
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Zip | 32223-1842
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Country | US
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Telephone | 904-880-3271
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Fax | 904-880-3273
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Provider Business Mailing Address
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Address Line | 12058 SAN JOSE BLVD STE 301
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City | JACKSONVILLE
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State | FL
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Zip | 32223-1842
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Country | US
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Telephone | 904-880-3271
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Fax | 904-880-3273
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Authorized Official
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Title or Position | ASSOCIATE
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Name | WILLIAM MOLESKY
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Credential | D.C
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Telephone | 904-880-3271
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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 | CH9192
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License Number State | FL
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