Provider Demographics
NPI:1720383151
Name:AZZOLINO, CHANNING (DC)
Entity Type:Individual
Prefix:DR
First Name:CHANNING
Middle Name:
Last Name:AZZOLINO
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 1:193 LASATA CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4414
Mailing Address - Country:US
Mailing Address - Phone:925-337-6096
Mailing Address - Fax:925-406-4742
Practice Address - Street 1:193 LASATA CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4414
Practice Address - Country:US
Practice Address - Phone:925-337-6096
Practice Address - Fax:925-406-4742
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26068111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology