Provider Demographics
NPI:1972897817
Name:DESULME, JOUBERT (DC,)
Entity type:Individual
Prefix:DR
First Name:JOUBERT
Middle Name:
Last Name:DESULME
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 1:12000 4TH ST N
Mailing Address - Street 2:APT 141
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1733
Mailing Address - Country:US
Mailing Address - Phone:727-421-2139
Mailing Address - Fax:
Practice Address - Street 1:3775 CENTRAL AVE
Practice Address - Street 2:STE B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8338
Practice Address - Country:US
Practice Address - Phone:214-349-9432
Practice Address - Fax:972-200-0485
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11533111N00000X
TX11773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor