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General NPI Number Information
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NPI Number | 1184993511
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Entity Type | Organization
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Legal Business Name | ZIVKOVIC CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 4371 US HIGHWAY 17 STE 104
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4812
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Country | US
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Telephone | 904-278-4888
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Fax | 904-278-1166
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Provider Business Mailing Address
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Address Line | 4371 US HIGHWAY 17 STE 104
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4812
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Country | US
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Telephone | 904-278-4888
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Fax | 904-278-1166
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | RADOMIR ROBERT ZIVKOVIC
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Credential | D.C.
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Telephone | 904-278-4888
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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 | CH4708
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH4847
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License Number State | FL
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