Rejuvenx of St. Pete, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

REJUVENX OF ST. PETE, LLC

Practice address

5880 49TH St N Ste N105
St Petersburg, FL 33709-2150

Phone

(727) 291-1660

NPI assigned

Dec 3, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Timothy Decanio, DC

Title

Owner

Phone

(561) 422-1819

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638489600000",
    "number": "1154089498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1470A ROYAL PALM BEACH BLVD",
            "city": "ROYAL PALM BEACH",
            "state": "FL",
            "postal_code": "334111608",
            "telephone_number": "561-422-1819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5880 49TH ST N STE N105",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337092150",
            "telephone_number": "727-291-1660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUVENX OF ST. PETE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-03",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A",
        "authorized_official_last_name": "DECANIO",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-422-1819",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.