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General NPI Number Information
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NPI Number | 1487986782
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE CHIROPRACTIC & WELLNESS
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Dates
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Enumeration Date | 02/11/2010
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 1201 GUM BRANCH RD
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5016
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Country | US
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Telephone | 910-455-6696
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Fax |
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Provider Business Mailing Address
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Address Line | 1802 E ASH ST
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City | GOLDSBORO
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State | NC
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Zip | 27530-4045
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID J TAYLOR
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Credential | D.C.
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Telephone | 919-738-1214
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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 | 2621
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License Number State | NC
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