Healthcare Provider Details

I. General information

NPI: 1760571178
Provider Name (Legal Business Name): JOHN JOSEPH CIPRIANI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19315 W CATAWBA AVE SUITE 100
CORNELIUS NC
28031-8650
US

IV. Provider business mailing address

19315 W CATAWBA AVE STE 100
CORNELIUS NC
28031-5637
US

V. Phone/Fax

Practice location:
  • Phone: 704-896-1811
  • Fax: 704-896-1812
Mailing address:
  • Phone: 781-507-4228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3473
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: