Provider Demographics
NPI:1285252411
Name:CAPONI, ALYSSA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:ANN
Last Name:CAPONI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 PARK WEST BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7122
Mailing Address - Country:US
Mailing Address - Phone:843-352-3420
Mailing Address - Fax:
Practice Address - Street 1:1121 PARK WEST BLVD STE D
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7122
Practice Address - Country:US
Practice Address - Phone:843-352-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor