Provider Demographics
NPI:1902162555
Name:PHYSICIANS HEALTH CENTER OF NORTH FLORIDA
Entity Type:Organization
Organization Name:PHYSICIANS HEALTH CENTER OF NORTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LITTLEFIELD
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:904-236-4619
Mailing Address - Street 1:3161 BOSTON HWY
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-4401
Mailing Address - Country:US
Mailing Address - Phone:904-236-4619
Mailing Address - Fax:904-367-0290
Practice Address - Street 1:4000 SAINT JOHNS AVE
Practice Address - Street 2:SUITE 35
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-9357
Practice Address - Country:US
Practice Address - Phone:904-236-4619
Practice Address - Fax:904-367-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty