Healthcare Provider Details

I. General information

NPI: 1306628987
Provider Name (Legal Business Name): ANDREW DAVID JEPSEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 RADIO RD STE 110
NAPLES FL
34104-3741
US

IV. Provider business mailing address

3960 RADIO RD STE 110
NAPLES FL
34104-3741
US

V. Phone/Fax

Practice location:
  • Phone: 239-465-0656
  • Fax: 239-465-0656
Mailing address:
  • Phone: 239-465-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH14972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: