Provider Demographics
NPI:1083437263
Name:PRECISION INJURY AND REHAB CLINIC LLC
Entity type:Organization
Organization Name:PRECISION INJURY AND REHAB CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DISTEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-317-3214
Mailing Address - Street 1:5775 ORTEGA VIEW WAY UNIT 13
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-7864
Mailing Address - Country:US
Mailing Address - Phone:904-420-8711
Mailing Address - Fax:
Practice Address - Street 1:5775 ORTEGA VIEW WAY UNIT 13
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-7864
Practice Address - Country:US
Practice Address - Phone:904-420-8711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty