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General NPI Number Information
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NPI Number | 1366504003
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Entity Type | Organization
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Legal Business Name | ORANGE PARK CHIROPRACTIC CENTER PA
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 868 BLANDING BLVD SUITE 128
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City | ORANGE PARK
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State | FL
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Zip | 32065
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Country | US
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Telephone | 904-272-4555
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Fax | 904-276-2521
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Provider Business Mailing Address
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Address Line | 868 BLANDING BLVD SUITE 128
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City | ORANGE PARK
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State | FL
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Zip | 32065-8942
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Country | US
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Telephone | 904-272-4555
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Fax | 904-276-2521
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Authorized Official
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Title or Position | PRESIDENT PHYSICIAN
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Name | DR. KEITH ALLEN SCHERTELL
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Credential | DC
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Telephone | 904-272-4555
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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 7619
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License Number State | FL
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