Provider Demographics
NPI:1912011305
Name:D'AGOSTINO, ANTHONY GERALD (DC, BA)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GERALD
Last Name:D'AGOSTINO
Suffix:
Gender:M
Credentials:DC, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 DEL PRADO BLVD S STE 8
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3714
Mailing Address - Country:US
Mailing Address - Phone:239-573-8918
Mailing Address - Fax:239-573-8920
Practice Address - Street 1:1338 DEL PRADO BLVD S STE 8
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3714
Practice Address - Country:US
Practice Address - Phone:239-573-8918
Practice Address - Fax:239-573-8920
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381333900Medicaid
FL53909ZOtherINDIVIDUAL PTAN
FLCH 7971OtherFL LICENSE NUMBER
FLFB090AOtherGROUP PTAN
FL53909OtherFL BCBS NUMBER
FLFB090AOtherGROUP PTAN
FLCH 7971OtherFL LICENSE NUMBER
FL381333900Medicaid
FL65-0998786OtherTAX ID NUMBER