MEDICARE: DR. JACK R GIANGIULIO DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	23259	CA

General Provider Information

NPI Number	:	1053679696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK R GIANGIULIO DC

Provider Business Mailing Address
First Line	:	4533 MACARTHUR BLVD
Second Line	:	#546
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20250 SW ACACIA ST
Second Line	:	SUITE 150
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1735
Country	:	US
Telephone Number	:	949-371-5225
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	05/02/2012

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