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General NPI Number Information
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NPI Number | 1134469471
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Entity Type | Organization
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Legal Business Name | BOLD CITY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/24/2013
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Last Update Date | 07/14/2013
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Provider Practice Location Address
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Address Line | 8102 BLANDING BLVD STE 11
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City | JACKSONVILLE
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State | FL
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Zip | 32244-5825
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Country | US
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Telephone | 904-321-9629
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Fax |
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Provider Business Mailing Address
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Address Line | 8102 BLANDING BLVD STE 11
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City | JACKSONVILLE
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State | FL
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Zip | 32244-5825
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. ERIN ZOVATH
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Credential | D.C.
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Telephone | 904-321-9629
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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 10648
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License Number State | FL
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