Provider Demographics
NPI:1366649469
Name:GULF COAST ACUPUNCTURE & WELLNESS CLINIC, INC.
Entity Type:Organization
Organization Name:GULF COAST ACUPUNCTURE & WELLNESS CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEBONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-473-8978
Mailing Address - Street 1:642 N INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-2728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:642 N INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-2728
Practice Address - Country:US
Practice Address - Phone:941-473-8978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1555171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty