Provider Demographics
NPI:1326371857
Name:DE LOS SANTOS, ANTHONY RAFAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:RAFAEL
Last Name:DE LOS SANTOS
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 1:7331 OFFICE PARK PL
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8239
Mailing Address - Country:US
Mailing Address - Phone:321-987-4655
Mailing Address - Fax:321-751-1733
Practice Address - Street 1:7331 OFFICE PARK PL
Practice Address - Street 2:SUITE 400
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8239
Practice Address - Country:US
Practice Address - Phone:321-987-4655
Practice Address - Fax:321-751-1733
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor