Healthcare Provider Details

I. General information

NPI: 1992935829
Provider Name (Legal Business Name): JONATHAN DAVID LAVELLE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18570 SANDALWOOD POINTE 201
FORT MYERS FL
33908-4787
US

IV. Provider business mailing address

18570 SANDALWOOD POINTE 201
FORT MYERS FL
33908-4787
US

V. Phone/Fax

Practice location:
  • Phone: 203-770-5266
  • Fax:
Mailing address:
  • Phone: 203-770-5266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: