Provider Demographics
NPI:1154624625
Name:JACKSONVILLE INJURY & REHAB
Entity type:Organization
Organization Name:JACKSONVILLE INJURY & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:MAURICIO
Authorized Official - Last Name:TRIANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-278-7411
Mailing Address - Street 1:859 PARK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4187
Mailing Address - Country:US
Mailing Address - Phone:904-278-7411
Mailing Address - Fax:904-278-4446
Practice Address - Street 1:859 PARK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4187
Practice Address - Country:US
Practice Address - Phone:904-278-7411
Practice Address - Fax:904-278-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty