Provider Demographics
NPI:1285777961
Name:CIANCIOLO, LEONARD JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:JOHN
Last Name:CIANCIOLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1723
Mailing Address - Country:US
Mailing Address - Phone:415-346-2445
Mailing Address - Fax:415-346-2449
Practice Address - Street 1:3637 SACRAMENTO ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1723
Practice Address - Country:US
Practice Address - Phone:415-346-2445
Practice Address - Fax:415-346-2449
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04220Medicare UPIN
CADC11180Medicare ID - Type Unspecified