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General NPI Number Information
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NPI Number | 1497126536
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CONCIERGE
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 11443 MARIPOE RD
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City | WEEKI WACHEE
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State | FL
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Zip | 34614-3507
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Country | US
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Telephone | 828-582-1403
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Fax | 813-444-3193
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Provider Business Mailing Address
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Address Line | 11443 MARIPOE RD
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City | WEEKI WACHEE
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State | FL
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Zip | 34614-3507
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Country | US
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Telephone | 828-582-1403
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Fax | 813-444-3193
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JESSICA MARIE ALLEN
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Credential | DC
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Telephone | 828-582-1403
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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 | CH11214
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License Number State | FL
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