Healthcare Provider Details

I. General information

NPI: 1447324124
Provider Name (Legal Business Name): DAGOSTINO CHIROPRACTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41750 RANCHO LAS PALMAS DR STE E2
RANCHO MIRAGE CA
92270-5511
US

IV. Provider business mailing address

41750 RANCHO LAS PALMAS DR STE E2
RANCHO MIRAGE CA
92270-5511
US

V. Phone/Fax

Practice location:
  • Phone: 760-773-2600
  • Fax: 760-773-2608
Mailing address:
  • Phone: 760-773-2600
  • Fax: 760-773-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC15171
License Number StateCA

VIII. Authorized Official

Name: DR. CHRIS MICHAEL DAGOSTINO
Title or Position: PRESIDENT
Credential: D.C.
Phone: 760-773-2600