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General NPI Number Information
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NPI Number | 1578204459
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Entity Type | Organization
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Legal Business Name | CHIRO & LASER ST. AUGUSTINE, PLLC
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 1092 S PONCE DE LEON BLVD STE K
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-6018
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Country | US
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Telephone | 940-460-2923
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Fax |
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Provider Business Mailing Address
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Address Line | 1092 S PONCE DE LEON BLVD STE K
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-6018
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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 | DR. JASON PALMER
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Credential |
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Telephone | 909-800-5839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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