Provider Demographics
NPI:1881924546
Name:SPELL, DERMONT MATARJARO (DC)
Entity type:Individual
Prefix:DR
First Name:DERMONT
Middle Name:MATARJARO
Last Name:SPELL
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 1:130 LETOURNEU CIRCLE BLDG 90311
Mailing Address - Street 2:
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:52544-5613
Mailing Address - Country:US
Mailing Address - Phone:850-881-4327
Mailing Address - Fax:
Practice Address - Street 1:130 LETOURNEU CIRCLE BLDG 90311
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:52544-5613
Practice Address - Country:US
Practice Address - Phone:850-881-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-27702111N00000X
SC4289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor