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General NPI Number Information
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NPI Number | 1336497916
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Entity Type | Organization
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Legal Business Name | SURFSIDE CHIROPRACTIC OF JACKSONVILLE, LLC
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 469 ATLANTIC BLVD UNIT 8
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233
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Country | US
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Telephone | 904-241-8302
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Fax |
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Provider Business Mailing Address
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Address Line | 469 ATLANTIC BLVD UNIT 8
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233
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Country | US
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Telephone | 904-241-8302
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. RICHARD NICHOLAS BAIATA
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Credential | D.C.
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Telephone | 917-204-4166
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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 | CH 10325
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License Number State | FL
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