Doctor Name: | DR. MARYDEE LYNN VAILE |
NPI Number: | 1164792289 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.C. |
License Number: | 3682 |
Business Practice Address: | 11740-2 San Jose Blvd Jacksonville, FL - 322231629 |
Business Phone Number: | 9048805755 |
Business Fax Number: | |
Mailing Address: | 1200 Plantation Island Dr S, Suite 230 ST AUGUSTINE |
State: | FL |
Postal Code: | 320803113 |
Phone Number: | 2028213097 |
Fax Number: | |
NPI Enumeration Date: | 01/05/2012 |
NPI Last Update Date: | 01/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 3682 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | SC |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |