MEDICARE: PREMIER HEALTH ENTERPRISES, INC

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	CH10080	FL

General Provider Information

NPI Number	:	1043585888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HEALTH ENTERPRISES, INC

Provider Business Mailing Address
First Line	:	2820 GIBSON RD
Second Line	:	SUITE #A
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-4804
Country	:	US
Telephone Number	:	904-503-2745
Fax Number	:	904-503-2746

Provider Business Practice Location Address
First Line	:	2820 GIBSON RD
Second Line	:	SUITE #A
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-4804
Country	:	US
Telephone Number	:	904-503-2745
Fax Number	:	904-503-2746

Authorized Official
Title or Position	:	CHIROPRACTIC SERVICES DIRECTOR
Name	:	DR. CHRISTOPHER R BURNHAM
Credential	:	D.C., B.S.
Telephone Number	:	904-503-2745

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	07/19/2012

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