Provider Demographics
NPI:1700358397
Name:ROBERT J. INDELICATO DC
Entity Type:Organization
Organization Name:ROBERT J. INDELICATO DC
Other - Org Name:INDELICATO FAMILY CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:INDELICATO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-746-2612
Mailing Address - Street 1:407 6TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1927
Mailing Address - Country:US
Mailing Address - Phone:941-746-2612
Mailing Address - Fax:941-746-2789
Practice Address - Street 1:407 6TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1927
Practice Address - Country:US
Practice Address - Phone:941-746-2612
Practice Address - Fax:941-746-2789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1609196260Medicaid
FL381843800Medicaid
FL1801804919Medicaid