Provider Demographics
NPI:1821161217
Name:AGLIATA, JACK P (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:P
Last Name:AGLIATA
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-4336
Mailing Address - Country:US
Mailing Address - Phone:386-454-4055
Mailing Address - Fax:386-454-9836
Practice Address - Street 1:105 NE 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-4336
Practice Address - Country:US
Practice Address - Phone:386-454-4055
Practice Address - Fax:386-454-9836
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor