Provider Demographics
NPI:1336233188
Name:DITOMMASO, GUY ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:GUY
Middle Name:ANDREW
Last Name:DITOMMASO
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13720 N CLEVELAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4300
Mailing Address - Country:US
Mailing Address - Phone:239-997-8100
Mailing Address - Fax:239-997-4817
Practice Address - Street 1:9175 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2027
Practice Address - Country:US
Practice Address - Phone:804-944-4576
Practice Address - Fax:804-944-4534
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9624111N00000X
NJ38MC00194000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ117835XBJMedicare PIN