Provider Demographics
NPI:1497846596
Name:FARO, ANTHONY EDWARD III (BS,MS,DC,FIAMA)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:EDWARD
Last Name:FARO
Suffix:III
Gender:M
Credentials:BS,MS,DC,FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S SCENIC HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-3827
Mailing Address - Country:US
Mailing Address - Phone:863-676-2225
Mailing Address - Fax:863-676-0698
Practice Address - Street 1:100 S SCENIC HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-3827
Practice Address - Country:US
Practice Address - Phone:863-676-2225
Practice Address - Fax:863-676-0698
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU39492Medicare UPIN
FL22846Medicare ID - Type UnspecifiedANTHONY FARO