Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH13418 | FL |
NPI | 1003492638 |
---|---|
Provider Name | Chelsea Bullard |
First Address | Jacksonville, FL 32257-5467 |
Second Address | Jacksonville, FL 32257-5467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2021 |
Last Update Date | 23/03/2021 |