MEDICARE: DR. ROBERT DEVINCENTIS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	CH0007521	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053306563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DEVINCENTIS D.C.

Provider Business Mailing Address
First Line	:	14255 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-1545
Country	:	US
Telephone Number	:	904-223-1616
Fax Number	:	904-223-1702

Provider Business Practice Location Address
First Line	:	14255 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-1545
Country	:	US
Telephone Number	:	904-223-1616
Fax Number	:	904-223-1702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	04/23/2008

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