Provider Demographics
NPI:1912547720
Name:SEPULVEDA, LUIS JOSE (DC)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:JOSE
Last Name:SEPULVEDA
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 1:12437 BRANTLEY COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5682
Mailing Address - Country:US
Mailing Address - Phone:888-261-9065
Mailing Address - Fax:
Practice Address - Street 1:12437 BRANTLEY COMMONS CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5682
Practice Address - Country:US
Practice Address - Phone:888-261-9065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor