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General NPI Number Information
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NPI Number | 1952855660
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Entity Type | Organization
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Legal Business Name | DURSO CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 2104 W NEW HAVEN AVE
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-3864
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Country | US
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Telephone | 321-379-1404
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Fax |
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Provider Business Mailing Address
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Address Line | 496 HORSEMINT AVE
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-8217
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Country | US
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Telephone | 321-917-4413
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JESSICA L DURSO
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Credential | DC
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Telephone | 321-917-4413
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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 | B-01476
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License Number State | NV
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