Provider Demographics
NPI:1962527622
Name:AGNELLI, DUSTIN LIVINGSTON (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:LIVINGSTON
Last Name:AGNELLI
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 1:1254 IRVINE BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3509
Mailing Address - Country:US
Mailing Address - Phone:949-899-4040
Mailing Address - Fax:
Practice Address - Street 1:1254 IRVINE BLVD
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3509
Practice Address - Country:US
Practice Address - Phone:949-899-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1088111N00000X
CA30882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor