Jacksonville Accident and Sports Injury Center LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

JACKSONVILLE ACCIDENT AND SPORTS INJURY CENTER LLC

Practice address

4235 Sunbeam Rd
Jacksonville, FL 32257-6013

Phone

(772) 546-9591

NPI assigned

Aug 9, 2017

Organization subpart

No

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

Authorized official

Name

Jeneane Wakula

Title

Office Manager

Phone

(772) 546-9591

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1502236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502236800000",
    "number": "1922523166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8929 SE BRIDGE RD",
            "city": "HOBE SOUND",
            "state": "FL",
            "postal_code": "334555312",
            "telephone_number": "772-546-9591",
            "fax_number": "772-546-9535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4235 SUNBEAM RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322576013",
            "telephone_number": "772-546-9591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE ACCIDENT AND SPORTS INJURY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-09",
        "last_updated": "2017-08-09",
        "status": "A",
        "authorized_official_last_name": "WAKULA",
        "authorized_official_first_name": "JENEANE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "772-546-9591"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC LICENSE",
            "identifier": "CH0007334",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany C Jackson, LMT
• Trichina Shalee Jackson
• Tyler Jackson
• Willie Jackson, BS
• Zamekio Jackson
• Jacksonville Acuhealth, Inc.
• Jacksonville Anesthesia Corporation Inc
• Jacksonville Autism Clinic LLC
• Jacksonville Autistic Society
• Jacksonville Beach Psychiatric Service

• 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 9, 2017; 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.