1255617502 NPI number — LEGACY CHIROPRACTIC PARTNERS LLC

Table of content: MR. QUINTEN J. HARVEY PH.D. (NPI 1932421161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255617502 NPI number — LEGACY CHIROPRACTIC PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEGACY CHIROPRACTIC PARTNERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255617502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 SAINT JOHNS AVE
Provider Second Line Business Mailing Address:
SUITE 35
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32205-9352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-236-4619
Provider Business Mailing Address Fax Number:
904-367-0290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 SAINT JOHNS AVE
Provider Second Line Business Practice Location Address:
SUITE 35
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32205-9352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-236-4619
Provider Business Practice Location Address Fax Number:
904-367-0290
Provider Enumeration Date:
11/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MANION
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
EARL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
904-236-4619

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH9834 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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