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General NPI Number Information
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NPI Number | 1891991386
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Entity Type | Organization
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Legal Business Name | DECOMPRESSION AND SPINAL REHAB OF SWFL
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 16517 VANDERBILT DR SUITE 1
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-7550
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Country | US
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Telephone | 239-947-7844
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Fax | 239-947-6338
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Provider Business Mailing Address
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Address Line | 16517 VANDERBILT DR SUITE 1
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-7550
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Country | US
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Telephone | 239-947-7844
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Fax | 239-947-6338
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. DAN BARTLEY
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Credential | D.C.
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Telephone | 239-947-7844
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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 | CH7598
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 6185490001
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT4617
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License Number State | FL
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