Organization Active NPI

Rejuvenx of Ft. Myers, LLC

  • Chiropractor
  • Fort Myers, FL
National Provider Identifier
1972276772
Registry record updated Jul 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
REJUVENX OF FT. MYERS, LLC
Practice address
6315 Presidential CT Ste 140
Fort Myers, FL 33919-3568
Phone
(239) 689-6042
NPI assigned
Jul 28, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2021

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

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

6315 Presidential CT Ste 140
Fort Myers, FL 33919-3568

Mailing address

1470A Royal Palm Beach Blvd
Royal Palm Beach, FL 33411-1608
Phone (561) 422-1819

National Provider Directory

National Provider Directory

Locations

6315 Presidential Ct
Ste 140
Fort Myers, FL 33919
Phone (239) 689-6042

1470A Royal Palm Beach Blvd
Royal Palm Beach, FL 33411

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1627430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627430400000",
    "number": "1972276772",
    "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": "6315 PRESIDENTIAL CT STE 140",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193568",
            "telephone_number": "239-689-6042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUVENX OF FT. MYERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-28",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "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": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.