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General NPI Number Information
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NPI Number | 1114914777
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Entity Type | Organization
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Legal Business Name | DISCOVER FAMILY CHIROPRACTIC INC
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 1339 BLANDING BLVD
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City | ORANGE PARK
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State | FL
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Zip | 32065-8022
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Country | US
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Telephone | 904-272-6886
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Fax |
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Provider Business Mailing Address
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Address Line | 1339 BLANDING BLVD
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City | ORANGE PARK
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State | FL
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Zip | 32065-7326
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Country | US
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Telephone | 904-272-6886
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Fax |
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Authorized Official
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Title or Position | DOCTOR / PRESIDENT
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Name | DR. DAVID OTTO
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Credential |
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Telephone | 904-272-6886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CH8245
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License Number State | FL
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