Provider Demographics
NPI:1235288499
Name:SCIOLINO, CHARLES VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:VINCENT
Last Name:SCIOLINO
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 1:255 W CENTRAL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3373
Mailing Address - Country:US
Mailing Address - Phone:714-255-7062
Mailing Address - Fax:714-255-8066
Practice Address - Street 1:255 W CENTRAL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3373
Practice Address - Country:US
Practice Address - Phone:714-255-7062
Practice Address - Fax:714-255-8066
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24048Medicare ID - Type Unspecified