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General NPI Number Information
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NPI Number | 1720497340
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Entity Type | Organization
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Legal Business Name | HAVLICEK CHIROPRACTIC INC
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 2085 A1A S STE 103
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-6505
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Country | US
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Telephone | 904-522-2515
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Fax | 904-515-2235
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Provider Business Mailing Address
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Address Line | 2085 A1A S STE 103
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-6505
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Country | US
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Telephone | 904-515-2225
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Fax | 904-515-2235
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADLEY HAVLICEK
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Credential | D.C.
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Telephone | 904-515-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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