Provider Demographics
NPI:1568430866
Name:SALVATORE LARUSSO D C P A II
Entity Type:Organization
Organization Name:SALVATORE LARUSSO D C P A II
Other - Org Name:FAMILY CHIROPRACTIC CENTER OF WEST LAKE WORTH, FL.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-641-4900
Mailing Address - Street 1:3938 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2944
Mailing Address - Country:US
Mailing Address - Phone:561-641-4900
Mailing Address - Fax:561-641-0136
Practice Address - Street 1:3938 PINEHURST DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2944
Practice Address - Country:US
Practice Address - Phone:561-641-4900
Practice Address - Fax:561-641-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005566111N00000X
FLND0001538133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3834Medicare PIN
FLT84273Medicare UPIN