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General NPI Number Information
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NPI Number | 1780886408
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Entity Type | Organization
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Legal Business Name | VANDERBILT CHIROPRACTIC CLINIC, PA
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 4530 TAMIAMI TRL N STE 2
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City | NAPLES
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State | FL
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Zip | 34103-3011
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Country | US
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Telephone | 239-596-8800
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Fax | 239-591-0737
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Provider Business Mailing Address
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Address Line | 4530 TAMIAMI TRL N STE 2
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City | NAPLES
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State | FL
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Zip | 34103-3011
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Country | US
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Telephone | 239-596-8800
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Fax | 239-591-0737
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS GERARD DISHAUZI
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Credential | D.C.
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Telephone | 239-596-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH8291
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License Number State | FL
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