MEDICARE: DR. KATHERINE CELESTE IACUONE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	7799	AZ

General Provider Information

NPI Number	:	1992840102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE CELESTE IACUONE DC

Provider Business Mailing Address
First Line	:	720 E THUNDERBIRD RD
Second Line	:	#1
City	:	PHOENIX
State	:	AZ
Zip	:	85022-5396
Country	:	US
Telephone Number	:	602-439-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 E THUNDERBIRD RD
Second Line	:	#1
City	:	PHOENIX
State	:	AZ
Zip	:	85022-5396
Country	:	US
Telephone Number	:	602-439-1515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	12/03/2009

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