Provider Demographics
NPI:1699825240
Name:ZULUAGA, CARLOS (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:ZULUAGA
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 1:4631 NW 53RD AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8302
Mailing Address - Country:US
Mailing Address - Phone:352-378-8500
Mailing Address - Fax:
Practice Address - Street 1:4631 NW 53RD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8302
Practice Address - Country:US
Practice Address - Phone:352-378-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55448Medicare ID - Type Unspecified
FLU62404Medicare UPIN