Provider Demographics
NPI:1972752822
Name:HUTZELL, JACOB JUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JUSTIN
Last Name:HUTZELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11808 SAN JOSE BLVD
Mailing Address - Street 2:STE # 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-0754
Mailing Address - Country:US
Mailing Address - Phone:904-880-3271
Mailing Address - Fax:904-880-3273
Practice Address - Street 1:11808 SAN JOSE BLVD
Practice Address - Street 2:STE # 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-0754
Practice Address - Country:US
Practice Address - Phone:904-880-3271
Practice Address - Fax:904-880-3273
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCH9481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor