Provider Demographics
NPI:1497179394
Name:DFCW LLC
Entity Type:Organization
Organization Name:DFCW LLC
Other - Org Name:DFCW LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:239-482-8686
Mailing Address - Street 1:6700 WINKLER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7235
Mailing Address - Country:US
Mailing Address - Phone:239-482-8686
Mailing Address - Fax:
Practice Address - Street 1:6700 WINKLER RD STE 3
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7235
Practice Address - Country:US
Practice Address - Phone:239-482-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6068AOtherMEDICARE ID
FL69003OtherBCBS
FLU72385Medicare UPIN