Provider Demographics
NPI:1912204124
Name:DEVICO GEWANT, ROBERT NEIL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NEIL
Last Name:DEVICO GEWANT
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 1:2401 PGA BLVD, #132
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3515
Mailing Address - Country:US
Mailing Address - Phone:561-627-5816
Mailing Address - Fax:
Practice Address - Street 1:2401 PGA BLVD, #132
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3515
Practice Address - Country:US
Practice Address - Phone:561-627-5816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor