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General NPI Number Information
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NPI Number | 1891920138
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Entity Type | Organization
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Legal Business Name | BAYMEADOWS CHIROPRACTIC AND PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 05/15/2009
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 8206 PHILIPS HWY
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City | JACKSONVILLE
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State | FL
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Zip | 32256-1220
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Country | US
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Telephone | 904-673-9691
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 COUNTY ROAD 210 W SUITE 108, BOX 327
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City | SAINT JOHNS
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State | FL
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Zip | 32259-4058
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MGRM
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Name | AGOSTINHO OLIVEIRA
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Credential | DC
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Telephone | 904-673-9691
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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 | CH9245
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License Number State | FL
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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 | CH9601
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License Number State | FL
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