Provider Demographics
NPI:1811038664
Name:CARISSIMI, THERESA A (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:A
Last Name:CARISSIMI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18690 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6004
Mailing Address - Country:US
Mailing Address - Phone:954-392-7700
Mailing Address - Fax:954-392-7711
Practice Address - Street 1:9710 STIRLING RD
Practice Address - Street 2:#112
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8018
Practice Address - Country:US
Practice Address - Phone:954-392-7700
Practice Address - Fax:954-392-7711
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor