Healthcare Provider Details

I. General information

NPI: 1801965363
Provider Name (Legal Business Name): ANTHONY J. CRISCUOLO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HUBBARD DR
HEATH TX
75032-8695
US

IV. Provider business mailing address

209 HUBBARD DR
HEATH TX
75032-8695
US

V. Phone/Fax

Practice location:
  • Phone: 945-305-1950
  • Fax:
Mailing address:
  • Phone: 945-305-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number16488
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: