Provider Demographics
NPI:1801836010
Name:TINARI, DOMINICK ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:ANTHONY
Last Name:TINARI
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 1:19439 SHUMARD OAK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7262
Mailing Address - Country:US
Mailing Address - Phone:813-875-7900
Mailing Address - Fax:813-875-7930
Practice Address - Street 1:19439 SHUMARD OAK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7262
Practice Address - Country:US
Practice Address - Phone:813-875-7900
Practice Address - Fax:813-875-7930
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64012OtherBLUE CROSS AND BLUE SHIELD OF FLORIDA
FL021631000Medicaid
FL56MIEOtherNEW FLORIDA BLUE GROUP
FL64012OtherBLUE CROSS AND BLUE SHIELD OF FLORIDA