MEDICARE: FORT CAROLINE CLINIC OF 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	:	1710648746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT CAROLINE CLINIC OF CHIROPRACTIC

Provider Business Mailing Address
First Line	:	14097 PINE ISLAND DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-3110
Country	:	US
Telephone Number	:	814-590-4411
Fax Number	:

Provider Business Practice Location Address
First Line	:	12086 FORT CAROLINE RD STE 302
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-7639
Country	:	US
Telephone Number	:	904-902-4325
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. JEREMY E BRUBAKER
Credential	:	DC
Telephone Number	:	904-419-8898

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	01/03/2022

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Directions to “FORT CAROLINE CLINIC OF CHIROPRACTIC ” Practice Location

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