Provider Demographics
NPI:1902544364
Name:GROWTH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GROWTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHEVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORVATH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-625-7144
Mailing Address - Street 1:178 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3932
Mailing Address - Country:US
Mailing Address - Phone:904-625-7144
Mailing Address - Fax:
Practice Address - Street 1:14011 BEACH BLVD STE 240
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1694
Practice Address - Country:US
Practice Address - Phone:904-339-5667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty