Provider Demographics
NPI:1225067002
Name:CANCELOSA, VINCE GENE (DC)
Entity Type:Individual
Prefix:
First Name:VINCE
Middle Name:GENE
Last Name:CANCELOSA
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 1:12975 COLLIER BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-4004
Mailing Address - Country:US
Mailing Address - Phone:239-455-4181
Mailing Address - Fax:239-455-3896
Practice Address - Street 1:12975 COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-4004
Practice Address - Country:US
Practice Address - Phone:239-455-4181
Practice Address - Fax:239-455-3896
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55160ZMedicare PIN