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General NPI Number Information
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NPI Number | 1619488624
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Entity Type | Organization
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Legal Business Name | THRIVE FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 1616 JORK RD STE 302
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2494
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Country | US
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Telephone | 904-437-4546
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Fax | 904-437-4546
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Provider Business Mailing Address
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Address Line | 1616 JORK RD STE 302
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2494
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Country | US
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Telephone | 904-437-4546
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Fax | 904-437-4546
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. CRISTINA PADILLA BRAVO
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Credential | DC
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Telephone | 904-437-4546
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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 | FL11601
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License Number State | FL
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