Provider Demographics
NPI:1871507152
Name:ERNEST S. CARUSO, DC, PA
Entity Type:Organization
Organization Name:ERNEST S. CARUSO, DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MCC
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MCC
Authorized Official - Phone:954-563-4472
Mailing Address - Street 1:3350 NW BOCA RATON BLVD
Mailing Address - Street 2:SUITE A24
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6657
Mailing Address - Country:US
Mailing Address - Phone:561-447-2228
Mailing Address - Fax:561-447-2230
Practice Address - Street 1:3350 NW BOCA RATON BLVD
Practice Address - Street 2:SUITE A24
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6657
Practice Address - Country:US
Practice Address - Phone:561-447-2228
Practice Address - Fax:561-447-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7975111N00000X
FLPT21879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6825Medicare PIN