MEDICARE: D.C. DEWEESE, 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	CH8089	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972797579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D.C. DEWEESE, P.A.

Provider Business Mailing Address
First Line	:	1312 DUNN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4836
Country	:	US
Telephone Number	:	904-757-4786
Fax Number	:	904-757-4882

Provider Business Practice Location Address
First Line	:	1312 DUNN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4836
Country	:	US
Telephone Number	:	904-757-4786
Fax Number	:	904-757-4882

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. DAMON CHRIS DEWEESE
Credential	:	D.C.
Telephone Number	:	904-757-4786

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	03/19/2014

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