Provider Demographics
NPI:1518055649
Name:IANNACCONE, ALAN KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KEITH
Last Name:IANNACCONE
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 1:8385 BRENTWOOD BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1381
Mailing Address - Country:US
Mailing Address - Phone:925-516-9970
Mailing Address - Fax:925-516-3678
Practice Address - Street 1:8385 BRENTWOOD BLVD
Practice Address - Street 2:STE A
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1381
Practice Address - Country:US
Practice Address - Phone:925-516-9970
Practice Address - Fax:925-516-3678
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0240640Medicare ID - Type Unspecified
U58895Medicare UPIN