MEDICARE: DR. AMY HAWTHORNE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH14034	FL

General Provider Information

NPI Number	:	1033942917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY HAWTHORNE DC

Provider Business Mailing Address
First Line	:	7707 MERRILL RD UNIT 8730
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32239-7731
Country	:	US
Telephone Number	:	628-888-5951
Fax Number	:

Provider Business Practice Location Address
First Line	:	5627 ATLANTIC BLVD STE 7
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2267
Country	:	US
Telephone Number	:	904-206-7781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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