MEDICARE: BEACH BOULEVARD CHIROPRACTIC

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

General Provider Information

NPI Number	:	1619241890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH BOULEVARD CHIROPRACTIC

Provider Business Mailing Address
First Line	:	11915 BEACH BLVD
Second Line	:	SUITE 105
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-6704
Country	:	US
Telephone Number	:	904-683-0793
Fax Number	:	904-619-4740

Provider Business Practice Location Address
First Line	:	11915 BEACH BLVD
Second Line	:	SUITE 105
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-6704
Country	:	US
Telephone Number	:	904-683-0793
Fax Number	:	904-619-4740

Authorized Official
Title or Position	:	DOCTOR / MANAGER
Name	:	DR. BRIAN DANIEL WINKLER
Credential	:	D.C.
Telephone Number	:	954-801-4465

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	06/08/2012

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Directions to “BEACH BOULEVARD CHIROPRACTIC ” Practice Location

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