Provider Demographics
NPI:1578396214
Name:ACEVEDO NIEVES, JONATHAN XAVIER
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:XAVIER
Last Name:ACEVEDO NIEVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 FLORAL SPRINGS BLVD UNIT 7204
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-6804
Mailing Address - Country:US
Mailing Address - Phone:352-562-4186
Mailing Address - Fax:
Practice Address - Street 1:1200 FLORAL SPRINGS BLVD UNIT 7204
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6804
Practice Address - Country:US
Practice Address - Phone:352-562-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor