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Organization
JACKSONVILLE ACCIDENT AND SPORTS INJURY CENTER LLC
Active
Organization
JACKSONVILLE ACCIDENT AND SPORTS INJURY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENEANE WAKULA (OFFICE MANAGER)
(772) 546-9591
Entity
Organization
Contact information
Practice address
4235 SUNBEAM RD, JACKSONVILLE, FL 32257-6013
(772) 546-9591
Mailing address
8929 SE BRIDGE RD, HOBE SOUND, FL 33455-5312
(772) 546-9591
(772) 546-9535
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH0007334
CHIROPRACTIC LICENSE
FL
Enumeration date
08/09/2017
Last updated
08/09/2017
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