Provider Demographics
NPI:1699790303
Name:VISCUSI, CARMINE NICK JR (DC)
Entity type:Individual
Prefix:DR
First Name:CARMINE
Middle Name:NICK
Last Name:VISCUSI
Suffix:JR
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 1:3000 ALAMO DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6352
Mailing Address - Country:US
Mailing Address - Phone:707-448-5433
Mailing Address - Fax:707-451-1678
Practice Address - Street 1:3000 ALAMO DR STE 200
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6352
Practice Address - Country:US
Practice Address - Phone:707-448-5433
Practice Address - Fax:707-451-1678
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0193160Medicare ID - Type Unspecified