Provider Demographics
NPI:1871743740
Name:NORTH FLORIDA CHIROPRACTIC INJURY CENTER PA
Entity type:Organization
Organization Name:NORTH FLORIDA CHIROPRACTIC INJURY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLANDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-272-4329
Mailing Address - Street 1:2230 SANDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-9559
Mailing Address - Country:US
Mailing Address - Phone:904-272-4329
Mailing Address - Fax:904-375-8852
Practice Address - Street 1:223 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3357
Practice Address - Country:US
Practice Address - Phone:904-272-4329
Practice Address - Fax:904-375-8852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55925OtherBCBS
FL381299500Medicaid
U81302Medicare UPIN