Provider Demographics
NPI:1508920711
Name:GUARDINO, CHRISTINE C (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:C
Last Name:GUARDINO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CREE
Other - Middle Name:C
Other - Last Name:GUARDINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1076 MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-4321
Mailing Address - Country:US
Mailing Address - Phone:408-265-2663
Mailing Address - Fax:408-979-9968
Practice Address - Street 1:1076 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-4321
Practice Address - Country:US
Practice Address - Phone:408-265-2663
Practice Address - Fax:408-979-9968
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0243890Medicare ID - Type Unspecified