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General NPI Number Information
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NPI Number | 1487892030
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Entity Type | Organization
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Legal Business Name | SOUTH MANDARIN CHIROPRACTIC AND WELLNESS, INC.
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 11808 SAN JOSE BLVD STE. 2
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City | JACKSONVILLE
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State | FL
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Zip | 32223-0754
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Country | US
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Telephone | 904-880-3271
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Fax | 904-880-3273
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Provider Business Mailing Address
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Address Line | 11808 SAN JOSE BLVD STE. 2
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City | JACKSONVILLE
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State | FL
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Zip | 32223-0754
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Country | US
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Telephone | 904-880-3271
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Fax | 904-880-3273
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. JACOB JUSTIN HUTZELL
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Credential | D,C,
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Telephone | 904-880-3271
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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 | CH9481
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License Number State | FL
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