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General NPI Number Information
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NPI Number | 1902382278
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Entity Type | Organization
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Legal Business Name | JUPITER CHIROPRACTIC AND SPORTS MEDICINE, PLLC
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 1701 MILITARY TRL STE 145B
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City | JUPITER
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State | FL
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Zip | 33458-6330
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Country | US
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Telephone | 561-529-3646
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Fax | 561-529-3538
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Provider Business Mailing Address
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Address Line | 1701 MILITARY TRL STE 145B
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City | JUPITER
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State | FL
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Zip | 33458-6330
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Country | US
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Telephone | 561-529-3646
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Fax | 561-529-3538
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. JASON BIONDO
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Credential | DC
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Telephone | 561-529-3646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CH11952
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License Number State | FL
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