Healthcare Provider Details

I. General information

NPI: 1447571906
Provider Name (Legal Business Name): ROBERT J DECUBELLIS DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 BEE RIDGE RD
SARASOTA FL
34239-6413
US

IV. Provider business mailing address

2546 BEE RIDGE RD
SARASOTA FL
34239-6413
US

V. Phone/Fax

Practice location:
  • Phone: 941-925-2889
  • Fax: 941-925-2889
Mailing address:
  • Phone: 941-925-2889
  • Fax: 941-925-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH 5969
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT J DECUBELLIS
Title or Position: OWNER
Credential: DC
Phone: 941-925-2889