Healthcare Provider Details

I. General information

NPI: 1861907230
Provider Name (Legal Business Name): MICELI CHIROPRACTIC CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W WHITTIER BLVD
MONTEBELLO CA
90640-5320
US

IV. Provider business mailing address

100 W WHITTIER BLVD
MONTEBELLO CA
90640-5320
US

V. Phone/Fax

Practice location:
  • Phone: 323-721-3797
  • Fax: 323-721-4982
Mailing address:
  • Phone: 323-721-3797
  • Fax: 323-721-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberDC26298
License Number StateCA

VIII. Authorized Official

Name: JOANNE LOUISE MICELI
Title or Position: DOCTER
Credential: DC26298
Phone: 323-721-3797