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General NPI Number Information
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NPI Number | 1629453402
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Entity Type | Organization
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Legal Business Name | DECUBELLIS WELLNESS CENTER LLC
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 7337 LITTLE RD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-5521
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Country | US
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Telephone | 727-842-4476
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Fax |
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Provider Business Mailing Address
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Address Line | 7337 LITTLE RD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-5521
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Country | US
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Telephone | 727-842-4476
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | TIM DECUBELLIS
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Credential | D.C.
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Telephone | 727-842-4476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CH9644
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License Number State | FL
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