Healthcare Provider Details

I. General information

NPI: 1336771187
Provider Name (Legal Business Name): CIPPERONI SPORTS CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 N COAST HIGHWAY 101 STE A
ENCINITAS CA
92024-3254
US

IV. Provider business mailing address

244 N COAST HWY
ENCINITAS CA
92024-3254
US

V. Phone/Fax

Practice location:
  • Phone: 619-857-1467
  • Fax:
Mailing address:
  • Phone: 760-334-3699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY CIPPERONI
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 847-533-1184