Healthcare Provider Details

I. General information

NPI: 1619964491
Provider Name (Legal Business Name): AUSTIN EMIL DACANAY DC, MS, CCSP, ICSSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4961 VAN DYKE RD.
LUTZ FL
33558
US

IV. Provider business mailing address

4961 VAN DYKE RD
LUTZ FL
33558-4813
US

V. Phone/Fax

Practice location:
  • Phone: 813-908-8776
  • Fax: 813-908-8704
Mailing address:
  • Phone: 813-908-8776
  • Fax: 813-908-8704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8788
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3980
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: