Healthcare Provider Details

I. General information

NPI: 1851525174
Provider Name (Legal Business Name): ANTHONY DANIEL CISTERNINO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 SE 32ND TERRACE
CAPE FL
33904-4124
US

IV. Provider business mailing address

712 SE 32ND TER
CAPE CORAL FL
33904-4124
US

V. Phone/Fax

Practice location:
  • Phone: 708-220-6108
  • Fax:
Mailing address:
  • Phone: 708-220-6108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011420
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: