| NPI | 1720497340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY HAVLICEK President 904-515-2225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2020-10-02 |