Provider Demographics
NPI:1205187010
Name:HALSEY, DOUGLAS CHARLES (DC , ACUPUNCTURIST)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:HALSEY
Suffix:
Gender:M
Credentials:DC , ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28340 TRAILS EDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7586
Mailing Address - Country:US
Mailing Address - Phone:239-949-6811
Mailing Address - Fax:239-992-6134
Practice Address - Street 1:28340 TRAILS EDGE BLVD
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7586
Practice Address - Country:US
Practice Address - Phone:239-949-6811
Practice Address - Fax:239-992-6134
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHN432AOtherMEDICARE - PTAN