Provider Demographics
NPI:1063982320
Name:PRADO CHIROPRACTIC AND ACUPUNCTURE
Entity type:Organization
Organization Name:PRADO CHIROPRACTIC AND ACUPUNCTURE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUYAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-246-9955
Mailing Address - Street 1:422 OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4077
Mailing Address - Country:US
Mailing Address - Phone:904-246-9955
Mailing Address - Fax:904-246-9956
Practice Address - Street 1:422 OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4077
Practice Address - Country:US
Practice Address - Phone:904-246-9955
Practice Address - Fax:904-246-9956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty