=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902929227
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELO M RUBANO JR. D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9400 GLADIOLUS DR SUITE 20
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33908-6699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-481-8811
-----------------------------------------------------
Fax | 239-481-8851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7268 SUGAR PALM CT
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33912-5728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-482-1801
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH8621
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------