Healthcare Provider Details

I. General information

NPI: 1285729871
Provider Name (Legal Business Name): AGOSTINHO M. OLIVEIRA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 HAMPTON POINT DR SUITE 4
ST AUGUSTINE FL
32092-3059
US

IV. Provider business mailing address

163 HAMPTON POINT DR SUITE 4
ST AUGUSTINE FL
32092-3059
US

V. Phone/Fax

Practice location:
  • Phone: 904-230-2717
  • Fax: 904-230-2720
Mailing address:
  • Phone: 904-230-2717
  • Fax: 904-230-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9245
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX008831-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104555764
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: