Healthcare Provider Details

I. General information

NPI: 1396778452
Provider Name (Legal Business Name): EUGENE JOHN URBISCI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5004 TAMIAMI TRL N
NAPLES FL
34103-2801
US

IV. Provider business mailing address

5004 TAMIAMI TRL N
NAPLES FL
34103-2801
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-5700
  • Fax:
Mailing address:
  • Phone: 239-261-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 4205
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: