Healthcare Provider Details

I. General information

NPI: 1538463567
Provider Name (Legal Business Name): STEVEN RALPH CUONO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 S NOVA RD
PORT ORANGE FL
32127-4910
US

IV. Provider business mailing address

3945 S NOVA RD
PORT ORANGE FL
32127-4910
US

V. Phone/Fax

Practice location:
  • Phone: 386-767-1100
  • Fax: 386-767-1103
Mailing address:
  • Phone: 386-767-1100
  • Fax: 386-767-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: