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General NPI Number Information
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NPI Number | 1568278968
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Entity Type | Organization
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Legal Business Name | INNOVO CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 145 LAND GRANT STREET, SUITE 4
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092
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Country | US
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Telephone | 904-250-0205
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Fax | 756-104-0591
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Provider Business Mailing Address
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Address Line | 145 LAND GRANT STREET, SUITE 4
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092
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Country | US
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Telephone | 904-250-0205
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Fax | 756-104-0591
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Authorized Official
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Title or Position | OWNER
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Name | DR. MEGAN SCHWEITZER
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Credential | DC
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Telephone | 920-277-2843
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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 |
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License Number State |
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