Provider Demographics
NPI:1730124207
Name:DISHAUZI, DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:DISHAUZI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 VANDERBILT BEACH ROAD EXT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2654
Mailing Address - Country:US
Mailing Address - Phone:239-596-8800
Mailing Address - Fax:239-591-0737
Practice Address - Street 1:2430 VANDERBILT BEACH ROAD EXT
Practice Address - Street 2:SUITE 110
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2654
Practice Address - Country:US
Practice Address - Phone:239-596-8800
Practice Address - Fax:239-591-0737
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381909400Medicaid
FL70224YMedicare ID - Type Unspecified
FL381909400Medicaid