Provider Demographics
NPI:1619964491
Name:DACANAY, AUSTIN EMIL (DC, MS, CCSP, ICSSD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:EMIL
Last Name:DACANAY
Suffix:
Gender:M
Credentials:DC, MS, CCSP, ICSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4961 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4813
Mailing Address - Country:US
Mailing Address - Phone:813-908-8776
Mailing Address - Fax:813-908-8704
Practice Address - Street 1:4961 VAN DYKE RD.
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558
Practice Address - Country:US
Practice Address - Phone:813-908-8776
Practice Address - Fax:813-908-8704
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8788111N00000X
IA3980111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381971000Medicaid
FL88753WMedicare PIN
FLV01925Medicare UPIN