Provider Demographics
NPI:1669755948
Name:ANTHONY CARUSO PA
Entity type:Organization
Organization Name:ANTHONY CARUSO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-963-6227
Mailing Address - Street 1:3003 S CONGRESS AVE
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2169
Mailing Address - Country:US
Mailing Address - Phone:561-963-6227
Mailing Address - Fax:561-963-4199
Practice Address - Street 1:3003 S CONGRESS AVE
Practice Address - Street 2:SUITE 2F
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2169
Practice Address - Country:US
Practice Address - Phone:561-963-6227
Practice Address - Fax:561-963-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty