Organization
EAST COAST NEURO LLC
Active
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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