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General NPI Number Information
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NPI Number | 1629387832
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Entity Type | Organization
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Legal Business Name | J. DAVID SHORE, P.A.
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 2431 UNIVERSITY BLVD W
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2037
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Country | US
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Telephone | 904-733-8833
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Fax | 904-733-3617
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Provider Business Mailing Address
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Address Line | 2431 UNIVERSITY BLVD W
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2037
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Country | US
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Telephone | 904-733-8833
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Fax | 904-733-3617
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Authorized Official
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Title or Position | OFFICER
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Name | DR. JAMES DAVID SHORE
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Credential | DC
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Telephone | 904-733-8833
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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 | CH4821
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License Number State | FL
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