Healthcare Provider Details

I. General information

NPI: 1073845731
Provider Name (Legal Business Name): CASEY FUSTE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3785 NW 82ND AVE
DORAL FL
33166-6655
US

IV. Provider business mailing address

12000 NW 10TH AVE
NORTH MIAMI FL
33168-6315
US

V. Phone/Fax

Practice location:
  • Phone: 786-580-4754
  • Fax:
Mailing address:
  • Phone: 315-885-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH12265
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: