MEDICARE: DR. ANGELA CERICE IACOVINO D.C.

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	DC26556	CA
2	111NN1001X	Nutrition Chiropractor	DC26556	CA
3	111NS0005X	Sports Physician Chiropractor	DC26556	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC26556	OTHER	CA	COMMERCIAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	DC26556	OTHER	CA	TRICARE
4	DC26556	OTHER	CA	PPO
5	DC26556	OTHER	CA	HMO
6	DC0265560	OTHER	CA	BLUE CROSS/SHIELD

General Provider Information

NPI Number	:	1275635575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA CERICE IACOVINO D.C.

Provider Business Mailing Address
First Line	:	901 DOVER DRIVE,
Second Line	:	SUITE 234
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5515
Country	:	US
Telephone Number	:	949-642-8193
Fax Number	:	949-325-0817

Provider Business Practice Location Address
First Line	:	901 DOVER DR
Second Line	:	SUITE 234
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5538
Country	:	US
Telephone Number	:	949-642-8193
Fax Number	:	949-325-0817

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	03/17/2016

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Directions to “ DR. ANGELA CERICE IACOVINO D.C.” Practice Location

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