Provider Demographics
NPI:1902929227
Name:RUBANO, ANGELO M JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:M
Last Name:RUBANO
Suffix:JR
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 1:7268 SUGAR PALM CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-5728
Mailing Address - Country:US
Mailing Address - Phone:239-482-1801
Mailing Address - Fax:
Practice Address - Street 1:9400 GLADIOLUS DR
Practice Address - Street 2:SUITE 20
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-6699
Practice Address - Country:US
Practice Address - Phone:239-481-8811
Practice Address - Fax:239-481-8851
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU49692Medicare UPIN
FLU3405AMedicare ID - Type Unspecified