Healthcare Provider Details

I. General information

NPI: 1306331848
Provider Name (Legal Business Name): ALEC J MARCANTONIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 07/13/2024
Certification Date: 07/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 NE 27TH TER
POMPANO BEACH FL
33062-4225
US

IV. Provider business mailing address

1041 NE 27TH TER
POMPANO BEACH FL
33062-4225
US

V. Phone/Fax

Practice location:
  • Phone: 954-482-3117
  • Fax:
Mailing address:
  • Phone: 954-482-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL5975
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH15029
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: