Healthcare Provider Details

I. General information

NPI: 1568430866
Provider Name (Legal Business Name): SALVATORE LARUSSO D C P A II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3938 PINEHURST DRIVE
LAKE WORTH FL
33467-2944
US

IV. Provider business mailing address

3938 PINEHURST DR
LAKE WORTH FL
33467-2944
US

V. Phone/Fax

Practice location:
  • Phone: 561-641-4900
  • Fax: 561-641-0136
Mailing address:
  • Phone: 561-641-4900
  • Fax: 561-641-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0005566
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND0001538
License Number StateFL

VIII. Authorized Official

Name: DR. DEXTER D DIMARCO
Title or Position: PRESIDENT
Credential: DC
Phone: 561-641-4900