Provider Demographics
NPI:1639871924
Name:ACEVEDO, ISIDORO JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ISIDORO
Middle Name:
Last Name:ACEVEDO
Suffix:JR
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 1:2301 SR - 524
Mailing Address - Street 2:SUITE 180A
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926
Mailing Address - Country:US
Mailing Address - Phone:321-305-5766
Mailing Address - Fax:
Practice Address - Street 1:2301 SR -524
Practice Address - Street 2:SUITE 180A
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-3292
Practice Address - Country:US
Practice Address - Phone:321-587-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor