MEDICARE: LOGAN M EMHOLTZ 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	14757	FL

General Provider Information

NPI Number	:	1477325066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN M EMHOLTZ DC

Provider Business Mailing Address
First Line	:	3139 LAUREL GRV N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-7332
Country	:	US
Telephone Number	:	715-338-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	8110 BLANDING BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5823
Country	:	US
Telephone Number	:	904-379-4621
Fax Number	:

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

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	11/22/2023

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Directions to “ LOGAN M EMHOLTZ DC” Practice Location

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