Provider Demographics
NPI:1487753133
Name:DECUBELLIS, JAMIESON JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:JAMIESON
Middle Name:JOSEPH
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:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-0112
Mailing Address - Country:US
Mailing Address - Phone:508-694-3544
Mailing Address - Fax:
Practice Address - Street 1:76 MAIN STREET
Practice Address - Street 2:STE 201
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-0112
Practice Address - Country:US
Practice Address - Phone:508-694-3544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00387111N00000X
MA2179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007058862Medicare PIN