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General NPI Number Information
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NPI Number | 1427449867
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Entity Type | Organization
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Legal Business Name | JAQUA CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 6449 38TH AVE N SUITE B3
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City | SAINT PETERSBURG
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State | FL
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Zip | 33710-1655
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Country | US
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Telephone | 727-347-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 6449 38TH AVE N SUITE B3
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City | SAINT PETERSBURG
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State | FL
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Zip | 33710-1655
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Country | US
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Telephone | 727-347-2225
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. KIM JAQUA
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Credential | D.C.
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Telephone | 727-347-2225
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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 | 9579
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License Number State | FL
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