MEDICARE: DAVENPORT CHIROPRACTIC, P.A.

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	CH6642	FL

General Provider Information

NPI Number	:	1922263052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVENPORT CHIROPRACTIC, P.A.

Provider Business Mailing Address
First Line	:	2710 3RD ST S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6028
Country	:	US
Telephone Number	:	904-246-1512
Fax Number	:	904-246-8105

Provider Business Practice Location Address
First Line	:	2710 3RD ST S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6028
Country	:	US
Telephone Number	:	904-246-1512
Fax Number	:	904-246-8105

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. JULIE HARDIN DAVENPORT
Credential	:
Telephone Number	:	904-246-1512

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	07/29/2008

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