Fort Caroline Clinic of Chiropractic

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

FORT CAROLINE CLINIC OF CHIROPRACTIC

Practice address

12086 Fort Caroline Rd Ste 302
Jacksonville, FL 32225-7639

Phone

(904) 902-4325

NPI assigned

Jul 8, 2021

Organization subpart

No

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

Authorized official

Name

Jeremy Brubaker, D.CNPI 1891832812

Title

Member

Phone

(814) 590-4411

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher A Hoffman, DC

  • Chiropractor
  • Jacksonville, FL
  • NPI 1962964304
  Medicare reassignment NPD
• Jeremy E Brubaker, D.C.

  • Chiropractor
  • Jacksonville, FL
  • NPI 1891832812
  NPD Authorized official

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

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629504000000",
    "number": "1104497361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14097 PINE ISLAND DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322243110",
            "telephone_number": "814-590-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12086 FORT CAROLINE RD STE 302",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322257639",
            "telephone_number": "904-902-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT CAROLINE CLINIC OF CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-08",
        "last_updated": "2021-08-21",
        "certification_date": "2021-08-21",
        "status": "A",
        "authorized_official_last_name": "BRUBAKER",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "814-590-4411",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Forrest, LCSW
• Jesse Forshey Friedman, ARNP
• John G. Forster, MD
• Rebecca Forster, APRN
• Robert J Forster, MD
• Fort Caroline Clinic of Chiropractic
• Fort Caroline Gardens
• Johnnethel M Fort, OTR/L
• Kathleen Frank Fort, APRN
• Peter Anthony Fort, D.C

• Chiropractor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.