Healthcare Provider Details

I. General information

NPI: 1154435667
Provider Name (Legal Business Name): ANTHONY VISCUSI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5804 JOG RD
LAKE WORTH FL
33467-6511
US

IV. Provider business mailing address

5804 JOG RD
LAKE WORTH FL
33467-6511
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-7440
  • Fax: 561-967-9987
Mailing address:
  • Phone: 561-967-7440
  • Fax: 561-967-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: