Provider Demographics
NPI:1598441750
Name:REJUVENX OF SARASOTA LLC
Entity Type:Organization
Organization Name:REJUVENX OF SARASOTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DECANIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-422-1819
Mailing Address - Street 1:1470A ROYAL PALM BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1608
Mailing Address - Country:US
Mailing Address - Phone:561-422-1819
Mailing Address - Fax:
Practice Address - Street 1:2020 CATTLEMEN RD STE 300
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6283
Practice Address - Country:US
Practice Address - Phone:561-422-1819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty