Provider Demographics
NPI:1407103856
Name:GIANINO, CARISSA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:MARIE
Last Name:GIANINO
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 1:5055 HIGHWAY N
Mailing Address - Street 2:STE. # 105
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8034
Mailing Address - Country:US
Mailing Address - Phone:636-939-3990
Mailing Address - Fax:636-235-4200
Practice Address - Street 1:5055 HIGHWAY N
Practice Address - Street 2:STE. # 105
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63304-8034
Practice Address - Country:US
Practice Address - Phone:636-939-3990
Practice Address - Fax:636-235-4200
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012022716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor