Provider Demographics
NPI:1447545470
Name:DR. TONY D'AGOSTINO DC PA
Entity type:Organization
Organization Name:DR. TONY D'AGOSTINO DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AGOSTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-573-8918
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:239-910-7182
Mailing Address - Fax:
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:239-910-7182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53909ZOtherINDIVIDUAL PTAN
FLCH7971OtherSTATE LICENSE NUMBER
FLFB090AOtherGROUP PTAN