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General NPI Number Information
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NPI Number | 1255622049
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Entity Type | Organization
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Legal Business Name | SPINE & DISC CENTER
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 05/24/2017
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Provider Practice Location Address
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Address Line | 2233 PARK AVE 200-B
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City | ORANGE PARK
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State | FL
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Zip | 32073-5570
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Country | US
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Telephone | 904-375-2308
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Fax | 904-375-1954
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Provider Business Mailing Address
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Address Line | 2233 PARK AVE 200-B
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City | ORANGE PARK
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State | FL
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Zip | 32073-5570
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Country | US
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Telephone | 904-375-2308
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Fax | 904-375-1954
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. MICHAEL NATHAN MCDANIELS
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Credential | D.C.
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Telephone | 904-375-2308
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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 | CH9367
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License Number State | FL
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