Provider Demographics
NPI:1639143118
Name:LOMBARDI, PAUL M (DC, DABCO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:LOMBARDI
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7211
Mailing Address - Country:US
Mailing Address - Phone:321-636-6090
Mailing Address - Fax:321-632-5805
Practice Address - Street 1:111 N FISKE BLVD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7211
Practice Address - Country:US
Practice Address - Phone:321-636-6090
Practice Address - Fax:321-632-5805
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2878111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88237Medicare ID - Type Unspecified
FLT55752Medicare UPIN