Provider Demographics
NPI:1588690432
Name:DISHAUZI, DAVID ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:DISHAUZI
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 1:4530 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3011
Mailing Address - Country:US
Mailing Address - Phone:239-261-5222
Mailing Address - Fax:
Practice Address - Street 1:4530 TAMIAMI TRL N
Practice Address - Street 2:SUITE 2
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3011
Practice Address - Country:US
Practice Address - Phone:239-261-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4634977OtherAETNA
NY5899973OtherGHI
FL380969200Medicaid
FL593413870OtherTAX IDENTIFICATION
FL380969200Medicaid