Provider Demographics
NPI:1407856206
Name:POTALIVO, DEBORA SHALEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:SHALEEN
Last Name:POTALIVO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DEBORA
Other - Middle Name:RACHELL
Other - Last Name:SHALEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:607 DONNA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-5517
Mailing Address - Country:US
Mailing Address - Phone:951-654-0803
Mailing Address - Fax:951-654-9053
Practice Address - Street 1:607 DONNA WAY
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5517
Practice Address - Country:US
Practice Address - Phone:951-654-0803
Practice Address - Fax:951-654-9053
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor