Provider Demographics
NPI:1811174246
Name:O. NELSON DECAMP, JR.,D.C., P.A.
Entity type:Organization
Organization Name:O. NELSON DECAMP, JR.,D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:O
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:DECAMP
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:863-688-6679
Mailing Address - Street 1:202 ALLAMANDA DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2928
Mailing Address - Country:US
Mailing Address - Phone:863-688-6679
Mailing Address - Fax:863-687-0082
Practice Address - Street 1:202 ALLAMANDA DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2928
Practice Address - Country:US
Practice Address - Phone:863-688-6679
Practice Address - Fax:863-687-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001427111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40308Medicare PIN