Organization
NEURO DX SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE S PETRYK DC,DACNB,FACFN,FABES (PRESIDENT)
(239) 482-0300
Entity
Organization
Contact information
Practice address
8801 COLLEGE PKWY, SUITE 2, FORT MYERS, FL 33919-4882
(239) 482-0300
(239) 482-4757
Mailing address
15880 SUMMERLIN RD STE 300, PMB 106, FORT MYERS, FL 33908-9613
(239) 482-0300
(239) 482-4757
Taxonomy
Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
CH8431
FL
204R00000X
Electrodiagnostic Medicine Physician
Primary
OS7123
FL
208D00000X
General Practice Physician
OS7123
FL
293D00000X
Physiological Laboratory
—
FL
Other
Enumeration date
09/25/2009
Last updated
06/14/2012
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