Provider Demographics
NPI:1558482166
Name:IVALDI, CRISTINA ROSA (DC, CCSP)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ROSA
Last Name:IVALDI
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2733
Mailing Address - Country:US
Mailing Address - Phone:508-880-1556
Mailing Address - Fax:508-880-0491
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2733
Practice Address - Country:US
Practice Address - Phone:508-880-1556
Practice Address - Fax:508-880-0491
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1204111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4400119OtherUNITED HEALTHCARE
MA715095OtherTUFTS
MA0736083OtherAENTA
MA210894OtherACN GROUP
MA351132OtherHARVARD PILGRIM
MAY35332OtherBLUE CROSS & BLUE SHIELD
RI233602OtherBLUE CROSS & BLUE SHIELD
MAY35332OtherBLUE CROSS & BLUE SHIELD
MA351132OtherHARVARD PILGRIM