Deerwood Lake Chiropractic

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH6864 Issued in FL

Legal business name

DEERWOOD LAKE CHIROPRACTIC

Practice address

4540 Southside Blvd Ste 603
Jacksonville, FL 32216-5488

Phone

(904) 996-8660

Fax

(904) 996-8650

NPI assigned

Dec 10, 2007

Organization subpart

No

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

Authorized official

Name

Jennifer Miller

Title

Office Manager

Phone

(904) 996-8660

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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

• Peter Anthony Fort, D.C

  • Chiropractor
  • Jacksonville, FL
  • NPI 1942356720
  Medicare reassignment NPD

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

{
    "created_epoch": "1197244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777420800000",
    "number": "1295918548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4540 SOUTHSIDE BLVD STE 603",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165488",
            "telephone_number": "904-996-8660",
            "fax_number": "904-996-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 SOUTHSIDE BLVD STE 603",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165488",
            "telephone_number": "904-996-8660",
            "fax_number": "904-996-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEERWOOD LAKE CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-10",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "904-996-8660"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH6864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malu Deegan, LM CPM
• Hugh Deen, MD
• Deena S. Richman PHD PA
• Deep Beauty LLC
• Deerwood Dental Group
• Deborah L Dees, MA, CCC-SLP
• Nina Lynne Deese, BCBA
• Jessica Defazio, PA-C
• Michael Vincent Defazio, MD
• Define Wellness Chiropractic and Functional Medicine

• 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 Apr 29, 2026; 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.