Provider Demographics
NPI:1649245481
Name:AQUI, ALEXIS G (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:G
Last Name:AQUI
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 1:1350 E MAIN STREET
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830
Mailing Address - Country:US
Mailing Address - Phone:863-534-3288
Mailing Address - Fax:863-534-3436
Practice Address - Street 1:1350 E MAIN STREET
Practice Address - Street 2:SUITE B1
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830
Practice Address - Country:US
Practice Address - Phone:863-534-3288
Practice Address - Fax:863-534-3436
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U86594Medicare UPIN
FL53895Medicare ID - Type Unspecified