Healthcare Provider Details

I. General information

NPI: 1922702950
Provider Name (Legal Business Name): DANIELLE CIPOLLO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E CHAPMAN AVE
ORANGE CA
92866-2110
US

IV. Provider business mailing address

15631 PACIFIC ST
TUSTIN CA
92780-5021
US

V. Phone/Fax

Practice location:
  • Phone: 657-650-8983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: