Provider Demographics
NPI:1831394485
Name:DECUBELLIS, DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:DECUBELLIS
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 1:51 HOPKINS HILL RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6318
Mailing Address - Country:US
Mailing Address - Phone:401-521-1900
Mailing Address - Fax:401-828-3003
Practice Address - Street 1:143 WESTMINSTER ST
Practice Address - Street 2:303
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-2017
Practice Address - Country:US
Practice Address - Phone:401-521-1900
Practice Address - Fax:401-828-3003
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI201611867OtherCIGNA
RI220714OtherBLUE CROSS
RI201611867OtherAETNA
RI201611867OtherUHC
RI293455OtherBLUE CROSS
RI407192OtherBLUE CHIP
RI220714OtherBLUE CROSS