MEDICARE: PRINCE SAMUEL CUNNINGHAM DC

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	CH15714	FL

General Provider Information

NPI Number	:	1982562617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCE SAMUEL CUNNINGHAM DC

Provider Business Mailing Address
First Line	:	3021 N MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-2122
Country	:	US
Telephone Number	:	904-350-5544
Fax Number	:

Provider Business Practice Location Address
First Line	:	3021 N MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-2122
Country	:	US
Telephone Number	:	904-350-5544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ PRINCE SAMUEL CUNNINGHAM DC” Practice Location

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