MEDICARE: RIVER CITY 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	CH8547	FL

General Provider Information

NPI Number	:	1780962449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	9307 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5503
Country	:	US
Telephone Number	:	904-737-1111
Fax Number	:	904-737-1116

Provider Business Practice Location Address
First Line	:	9307 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5503
Country	:	US
Telephone Number	:	904-737-1111
Fax Number	:	904-737-1116

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DAVID ANDREW STEVE
Credential	:	D. C.
Telephone Number	:	904-737-1111

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	07/29/2011

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Directions to “RIVER CITY CHIROPRACTIC ” Practice Location

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