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General NPI Number Information
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NPI Number | 1255617502
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Entity Type | Organization
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Legal Business Name | LEGACY CHIROPRACTIC PARTNERS LLC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 4000 SAINT JOHNS AVE SUITE 35
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City | JACKSONVILLE
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State | FL
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Zip | 32205-9352
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Country | US
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Telephone | 904-236-4619
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Fax | 904-367-0290
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Provider Business Mailing Address
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Address Line | 4000 SAINT JOHNS AVE SUITE 35
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City | JACKSONVILLE
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State | FL
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Zip | 32205-9352
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Country | US
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Telephone | 904-236-4619
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Fax | 904-367-0290
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOEL EARL MANION
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Credential | D.C.
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Telephone | 904-236-4619
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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 | CH9834
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License Number State | FL
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