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General NPI Number Information
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NPI Number | 1265477848
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Entity Type | Organization
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Legal Business Name | AMELIA CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2888 S 8TH ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4462
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Country | US
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Telephone | 904-321-0002
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Fax | 904-321-1488
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Provider Business Mailing Address
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Address Line | 2888 S 8TH ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4462
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Country | US
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Telephone | 904-321-0002
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Fax | 904-321-1488
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID J FASHINGBAUER
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Credential | DC
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Telephone | 904-321-0002
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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 | CH6999
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License Number State | FL
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