NPIMap

Organization Active NPI

Ponte Vedra Chiropractic Medicine & Physical Therapy, Inc.

  • Chiropractor
  • Ponte Vedra Beach, FL
National Provider Identifier
1073799870
Registry record updated Dec 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH6259 Issued in FL
Legal business name
PONTE VEDRA CHIROPRACTIC MEDICINE & PHYSICAL THERAPY, INC.
Practice address
240 Ponte Vedra Park Dr
Suite 150
Ponte Vedra Beach, FL 32082-6601
Phone
(904) 285-2243
Fax
(904) 285-9022
NPI assigned
Jan 11, 2008
Last updated
Dec 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Richard G. Packo, D.C.NPI 1720057086
Title
President
Phone
(904) 285-2243

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH6259 FL Primary

Addresses

Primary practice location

240 Ponte Vedra Park Dr
Suite 150
Ponte Vedra Beach, FL 32082-6601

Mailing address

240 Ponte Vedra Park Dr
Suite 150
Ponte Vedra Beach, FL 32082-6601
Phone (904) 285-2243

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480636800000",
    "number": "1073799870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 PONTE VEDRA PARK DR",
            "address_2": "SUITE 150",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320826601",
            "telephone_number": "904-285-2243",
            "fax_number": "904-285-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 PONTE VEDRA PARK DR",
            "address_2": "SUITE 150",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320826601",
            "telephone_number": "904-285-2243",
            "fax_number": "904-285-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONTE VEDRA CHIROPRACTIC MEDICINE & PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-11",
        "last_updated": "2016-12-02",
        "status": "A",
        "authorized_official_last_name": "PACKO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-285-2243",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH6259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.