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Organization

EAST COAST NEURO LLC

Active
Other names
East Coast Injury Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
VANESSA JACLYN WILCZAK (OWNER AND AUTHORIZED OFFICIAL)
(904) 513-3954
Entity
Organization

Contact information

Practice address
10550 DEERWOOD PARK BLVD STE 609A, JACKSONVILLE, FL 32256-2811
(904) 513-3954
(904) 212-0223
Mailing address
PO BOX 936957, ATLANTA, GA 31193-6957
(941) 209-5410
(941) 209-5652

Taxonomy

Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
208100000X
Physical Medicine & Rehabilitation Physician
2084N0400X
Neurology Physician
Primary
225100000X
Physical Therapist

Other

Enumeration date
11/11/2014
Last updated
01/22/2026
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