MEDICARE: LAND CHIROPRACTIC AND SPORTS CLINIC LLC

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	CH9603	FL

General Provider Information

NPI Number	:	1164688354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAND CHIROPRACTIC AND SPORTS CLINIC LLC

Provider Business Mailing Address
First Line	:	8823 SAN JOSE BLVD
Second Line	:	SUITE 201
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4287
Country	:	US
Telephone Number	:	904-338-9995
Fax Number	:

Provider Business Practice Location Address
First Line	:	8823 SAN JOSE BLVD
Second Line	:	SUITE 201
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4287
Country	:	US
Telephone Number	:	904-338-9995
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTOPHER MICHAEL LAND
Credential	:	D.C.
Telephone Number	:	904-477-5057

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	09/17/2008

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