NPIMap

Organization Active NPI

Fernandina Chiropractic Center, Inc

  • Chiropractor
  • Yulee, FL
National Provider Identifier
1104121011
Registry record updated May 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH-3341 Issued in FL
Legal business name
FERNANDINA CHIROPRACTIC CENTER, INC
Practice address
464073 State Road 200
Suite 4
Yulee, FL 32097-6307
Phone
(904) 491-1345
Fax
(904) 491-1346
NPI assigned
Jan 24, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2011

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

Authorized official

Name
Dr. Bruce Steven Glickman, DC
Title
Owner
Phone
(904) 491-1345

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CH-3341 FL Primary

Addresses

Primary practice location

464073 State Road 200
Suite 4
Yulee, FL 32097-6307

Mailing address

464073 State Road 200
Suite 4
Yulee, FL 32097-6307
Phone (904) 491-1345

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1295827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305244800000",
    "number": "1104121011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "464073 STATE ROAD 200",
            "address_2": "SUITE 4",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "320976307",
            "telephone_number": "904-491-1345",
            "fax_number": "904-491-1346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "464073 STATE ROAD 200",
            "address_2": "SUITE 4",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "320976307",
            "telephone_number": "904-491-1345",
            "fax_number": "904-491-1346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FERNANDINA CHIROPRACTIC CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-24",
        "last_updated": "2011-05-13",
        "status": "A",
        "authorized_official_last_name": "GLICKMAN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-491-1345",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH-3341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yulee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; 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.