Provider Demographics
NPI:1982694956
Name:DIMARCO, DEXTER DANIEL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DEXTER
Middle Name:DANIEL
Last Name:DIMARCO
Suffix:JR
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 1:3938 PINEHURST DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467
Mailing Address - Country:US
Mailing Address - Phone:561-641-4900
Mailing Address - Fax:561-641-0136
Practice Address - Street 1:3938 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2944
Practice Address - Country:US
Practice Address - Phone:561-641-4900
Practice Address - Fax:561-641-0136
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052285600Medicaid
FL1568430866Medicare PIN
FL052285600Medicaid