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General NPI Number Information
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NPI Number | 1407072242
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Entity Type | Organization
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Legal Business Name | MUSA CHIROPRACTIC & WELLNESS CENTER INC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 1915 EAST WEST PKWY STE 1
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City | ORANGE PARK
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State | FL
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Zip | 32003-6350
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Country | US
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Telephone | 904-269-1799
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Fax | 904-269-0970
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Provider Business Mailing Address
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Address Line | 1915 EAST WEST PKWY STE 1
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City | ORANGE PARK
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State | FL
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Zip | 32003-6350
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Country | US
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Telephone | 904-269-1799
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Fax | 904-269-0970
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JOYCE TUCKER
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Credential |
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Telephone | 904-272-3440
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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 | CH008125
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License Number State | FL
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