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General NPI Number Information
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NPI Number | 1104990787
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Entity Type | Organization
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Legal Business Name | ANGELA IACOVINO CHIROPRACTIC, INC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 901 DOVER DR SUITE 234
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5538
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Country | US
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Telephone | 949-642-8193
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Fax | 949-642-8195
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Provider Business Mailing Address
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Address Line | 901 DOVER DR SUITE 234
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5538
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Country | US
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Telephone | 949-642-8193
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Fax | 949-642-8195
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Authorized Official
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Title or Position | OWNER D.C.
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Name | DR. ANGELA CERICE IACOVINO
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Credential | D.C.
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Telephone | 949-642-8193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC26556
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License Number State | CA
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