Provider Demographics
NPI:1316909237
Name:GIOVANINE, TERI (DC)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:GIOVANINE
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 1:587 HAMMOND ST
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2627
Mailing Address - Country:US
Mailing Address - Phone:760-873-8215
Mailing Address - Fax:760-873-6055
Practice Address - Street 1:587 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2627
Practice Address - Country:US
Practice Address - Phone:760-873-8215
Practice Address - Fax:760-873-6055
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T06481Medicare UPIN
CADC0174780Medicare ID - Type Unspecified