Provider Demographics
NPI:1982247029
Name:CASTRILLON, EMILIO JOSE SR (DC)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:JOSE
Last Name:CASTRILLON
Suffix:SR
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 1:2604 CYPRESS RIDGE BLVD STE 102-A
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6311
Mailing Address - Country:US
Mailing Address - Phone:813-560-4673
Mailing Address - Fax:888-728-0040
Practice Address - Street 1:2604 CYPRESS RIDGE BLVD
Practice Address - Street 2:STE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6311
Practice Address - Country:US
Practice Address - Phone:813-560-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor