| Deerwood Lake Chiropractic | |
|
4540 Southside Blvd, Ste. # 1101, Jacksonville, FL 32216-5492 | |
| (904) 996-8660 | |
| (904) 996-8650 |
| Full Name | Deerwood Lake Chiropractic |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 4540 Southside Blvd, Jacksonville, Florida |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295918548 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | CH6864 (Florida) | Primary |
| Provider Name | Peter Anthony Fort |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1942356720 PECOS PAC ID: 7416966486 Enrollment ID: I20060421000159 |
| Mailing Address | Practice Location Address |
|---|---|
| Deerwood Lake Chiropractic 4540 Southside Blvd, Ste. # 1101, Jacksonville, FL 32216-5492 Ph: (904) 996-8660 | Deerwood Lake Chiropractic 4540 Southside Blvd, Ste. # 1101, Jacksonville, FL 32216-5492 Ph: (904) 996-8660 |
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