Provider Demographics
NPI:1396990529
Name:MY CHIROPRACTOR OF SOUTH DAYTONA INC
Entity type:Organization
Organization Name:MY CHIROPRACTOR OF SOUTH DAYTONA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-756-0934
Mailing Address - Street 1:915 BIG TREE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-2517
Mailing Address - Country:US
Mailing Address - Phone:386-756-0934
Mailing Address - Fax:
Practice Address - Street 1:915 BIG TREE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2517
Practice Address - Country:US
Practice Address - Phone:386-756-0934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty