Healthcare Provider Details

I. General information

NPI: 1306818067
Provider Name (Legal Business Name): ANTHONY AQUINO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W CYPRESS CREEK RD C100
FORT LAUDERDALE FL
33309-1744
US

IV. Provider business mailing address

4623 FOREST HILL BLVD SUITE 101
WEST PALM BEACH FL
33415-9120
US

V. Phone/Fax

Practice location:
  • Phone: 954-974-3111
  • Fax: 954-974-6191
Mailing address:
  • Phone: 561-966-7194
  • Fax: 561-966-7191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: