Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 32571 | CA |
N | 111NN1001X | Nutrition | CHIA-1537 | ID |
NPI | 1508294844 |
---|---|
Provider Name | Dr. Joseph Iaccino |
First Address | Boise, ID 83702-6092 |
Second Address | Colusa, CA 95932-2534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2013 |
Last Update Date | 23/01/2020 |