Provider Demographics
NPI:1194831628
Name:AGOSTINO, LEONARD V III (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:V
Last Name:AGOSTINO
Suffix:III
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 1:1025 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4478
Mailing Address - Country:US
Mailing Address - Phone:954-458-1223
Mailing Address - Fax:954-458-6150
Practice Address - Street 1:6100 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5134
Practice Address - Country:US
Practice Address - Phone:954-458-1223
Practice Address - Fax:954-210-8854
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592231708OtherTAX IDENTIFICATION