Provider Demographics
NPI:1770663486
Name:DECANIO, TIMOTHY M (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:DECANIO
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 1:1470 ROYAL PALM BEACH BLVD STE A
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:561-422-1813
Practice Address - Street 1:1470 ROYAL PALM BEACH BLVD STE A
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1608
Practice Address - Country:US
Practice Address - Phone:561-422-1819
Practice Address - Fax:561-422-1813
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8849111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7323Medicare ID - Type Unspecified