Healthcare Provider Details

I. General information

NPI: 1336233188
Provider Name (Legal Business Name): GUY ANDREW DITOMMASO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9175 STAPLES MILL RD
RICHMOND VA
23228-2027
US

IV. Provider business mailing address

13720 N CLEVELAND AVE SUITE B
NORTH FORT MYERS FL
33903-4300
US

V. Phone/Fax

Practice location:
  • Phone: 804-944-4576
  • Fax: 804-944-4534
Mailing address:
  • Phone: 239-997-8100
  • Fax: 239-997-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9624
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00194000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: