Healthcare Provider Details

I. General information

NPI: 1609873157
Provider Name (Legal Business Name): RONALD M REPICE II D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 HERITAGE TRL STE 203
NAPLES FL
34112-8715
US

IV. Provider business mailing address

1715 HERITAGE TRL STE 203
NAPLES FL
34112-8715
US

V. Phone/Fax

Practice location:
  • Phone: 239-530-3040
  • Fax: 239-530-3050
Mailing address:
  • Phone: 239-530-3040
  • Fax: 239-530-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCH8620
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: