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General NPI Number Information
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NPI Number | 1346594322
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Entity Type | Organization
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Legal Business Name | JAX SPINE & REHAB PLLC
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 13475 ATLANTIC BLVD STE 28
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City | JACKSONVILLE
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State | FL
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Zip | 32225-3290
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Country | US
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Telephone | 904-333-6164
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Fax |
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Provider Business Mailing Address
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Address Line | 4216 RIPKEN CIR E
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City | JACKSONVILLE
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State | FL
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Zip | 32224-9675
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Country | US
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Telephone | 904-333-6164
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RICHARD ADAM CROSBY
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Credential | DC, ATC
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Telephone | 904-333-6164
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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 | CH9780
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License Number State | FL
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