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General NPI Number Information
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NPI Number | 1619241890
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Entity Type | Organization
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Legal Business Name | BEACH BOULEVARD CHIROPRACTIC
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 11915 BEACH BLVD SUITE 105
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City | JACKSONVILLE
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State | FL
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Zip | 32246-6704
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Country | US
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Telephone | 904-683-0793
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Fax | 904-619-4740
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Provider Business Mailing Address
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Address Line | 11915 BEACH BLVD SUITE 105
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City | JACKSONVILLE
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State | FL
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Zip | 32246-6704
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Country | US
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Telephone | 904-683-0793
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Fax | 904-619-4740
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Authorized Official
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Title or Position | DOCTOR / MANAGER
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Name | DR. BRIAN DANIEL WINKLER
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Credential | D.C.
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Telephone | 954-801-4465
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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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