Provider Demographics
NPI:1033195078
Name:ACQUARO, DENNIS A (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:ACQUARO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N BEACH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5656
Mailing Address - Country:US
Mailing Address - Phone:386-673-0201
Mailing Address - Fax:386-677-8143
Practice Address - Street 1:26 N BEACH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5656
Practice Address - Country:US
Practice Address - Phone:386-673-0201
Practice Address - Fax:386-677-8143
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89002OtherBCBS
FL050059300Medicaid
FLP00153054OtherRAILROAD MEDICARE PIN
FL74592Medicare PIN
FL89002OtherBCBS
FLT56051Medicare UPIN
FL050059300Medicaid