Healthcare Provider Details

I. General information

NPI: 1780886408
Provider Name (Legal Business Name): VANDERBILT CHIROPRACTIC CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 TAMIAMI TRL N STE 2
NAPLES FL
34103-3011
US

IV. Provider business mailing address

4530 TAMIAMI TRL N STE 2
NAPLES FL
34103-3011
US

V. Phone/Fax

Practice location:
  • Phone: 239-596-8800
  • Fax: 239-591-0737
Mailing address:
  • Phone: 239-596-8800
  • Fax: 239-591-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8291
License Number StateFL

VIII. Authorized Official

Name: DR. DOUGLAS GERARD DISHAUZI
Title or Position: PRESIDENT
Credential: D.C.
Phone: 239-596-8800