Provider Demographics
NPI:1427355247
Name:MCCUTCHEON, GAVIN JAMES (DC)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:JAMES
Last Name:MCCUTCHEON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12627 SAN JOSE BLVD
Mailing Address - Street 2:STE 106
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8637
Mailing Address - Country:US
Mailing Address - Phone:904-683-9698
Mailing Address - Fax:904-683-3941
Practice Address - Street 1:4401 EMERSON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4962
Practice Address - Country:US
Practice Address - Phone:904-399-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor