Healthcare Provider Details

I. General information

NPI: 1104990787
Provider Name (Legal Business Name): ANGELA IACOVINO CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DOVER DR SUITE 234
NEWPORT BEACH CA
92660-5538
US

IV. Provider business mailing address

901 DOVER DR SUITE 234
NEWPORT BEACH CA
92660-5538
US

V. Phone/Fax

Practice location:
  • Phone: 949-642-8193
  • Fax: 949-642-8195
Mailing address:
  • Phone: 949-642-8193
  • Fax: 949-642-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26556
License Number StateCA

VIII. Authorized Official

Name: DR. ANGELA CERICE IACOVINO
Title or Position: OWNER D.C.
Credential: D.C.
Phone: 949-642-8193