Provider Demographics
NPI:1053306563
Name:DEVINCENTIS, ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:DEVINCENTIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14255 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1545
Mailing Address - Country:US
Mailing Address - Phone:904-223-1616
Mailing Address - Fax:904-223-1702
Practice Address - Street 1:14255 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1545
Practice Address - Country:US
Practice Address - Phone:904-223-1616
Practice Address - Fax:904-223-1702
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007521111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381167100Medicaid
FL55756ZMedicare PIN
FLU72939Medicare UPIN