Provider Demographics
NPI:1326537820
Name:ISAZA, ADRIAN AUGUST (DC)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:AUGUST
Last Name:ISAZA
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 1:10320 N 56TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-4057
Mailing Address - Country:US
Mailing Address - Phone:813-989-9705
Mailing Address - Fax:
Practice Address - Street 1:2970 UNIVERSITY PKWY #204
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243
Practice Address - Country:US
Practice Address - Phone:813-989-9705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2022-01-06
Deactivation Date:2021-11-15
Deactivation Code:
Reactivation Date:2022-01-05
Provider Licenses
StateLicense IDTaxonomies
FL12477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor