Provider Demographics
NPI:1225192057
Name:DECUBELLIS, ROBERT J (DC, PA)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:DECUBELLIS
Suffix:
Gender:M
Credentials:DC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6413
Mailing Address - Country:US
Mailing Address - Phone:941-925-2889
Mailing Address - Fax:941-925-2889
Practice Address - Street 1:2546 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6413
Practice Address - Country:US
Practice Address - Phone:941-925-2889
Practice Address - Fax:941-925-2889
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH005969111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU12403Medicare UPIN
FL22609Medicare ID - Type Unspecified