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General NPI Number Information
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NPI Number | 1639343676
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Entity Type | Organization
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Legal Business Name | MANDARIN CHIROPRACTIC CENTER PA
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 9891 SAN JOSE BLVD STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32257-5488
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Country | US
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Telephone | 904-262-8600
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Fax | 904-262-3899
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Provider Business Mailing Address
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Address Line | 9891 SAN JOSE BLVD STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32257-5488
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Country | US
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Telephone | 904-262-8600
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Fax | 904-262-3899
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN NICKELS
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Credential | DC
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Telephone | 904-262-8600
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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 | CH6361
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License Number State | FL
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