Provider Demographics
NPI:1053437475
Name:FIRST COAST CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:FIRST COAST CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ZANE
Authorized Official - Last Name:FINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-246-3232
Mailing Address - Street 1:1482 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6310
Mailing Address - Country:US
Mailing Address - Phone:904-246-3232
Mailing Address - Fax:
Practice Address - Street 1:1482 3RD ST S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6310
Practice Address - Country:US
Practice Address - Phone:904-246-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70273OtherBCBS
FL70273OtherBCBS
FL70273ZMedicare ID - Type Unspecified