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General NPI Number Information
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NPI Number | 1194857359
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Entity Type | Organization
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Legal Business Name | DAYTONA CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 543 S RIDGEWOOD AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4929
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Country | US
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Telephone | 386-253-1113
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Fax |
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Provider Business Mailing Address
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Address Line | 543 S RIDGEWOOD AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4929
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Country | US
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Telephone | 386-253-1113
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW J. HILL
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Credential | D.C.
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Telephone | 386-253-1113
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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 | CH8693
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License Number State | FL
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