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General NPI Number Information
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NPI Number | 1437364320
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Entity Type | Organization
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Legal Business Name | 210 FAMILY CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 163 HAMPTON POINT DR SUITE 4
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-3059
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Country | US
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Telephone | 904-230-2717
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Fax | 904-230-2720
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Provider Business Mailing Address
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Address Line | 163 HAMPTON POINT DR SUITE 4
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-3059
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Country | US
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Telephone | 904-230-2717
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Fax | 904-230-2720
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Authorized Official
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Title or Position | OWNER
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Name | AGOSTINHO M OLIVEIRA
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Credential | DC
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Telephone | 904-230-2717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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