Provider Demographics
NPI:1912166349
Name:RIVER CITY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:RIVER CITY CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:STEVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-737-1111
Mailing Address - Street 1:9315 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5503
Mailing Address - Country:US
Mailing Address - Phone:904-737-1111
Mailing Address - Fax:904-737-1116
Practice Address - Street 1:9315 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5503
Practice Address - Country:US
Practice Address - Phone:904-737-1111
Practice Address - Fax:904-737-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8547111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty