Provider Demographics
NPI:1851401095
Name:CRESCI, DOMINIC A (DC)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:A
Last Name:CRESCI
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 1:700 S CLAREMONT ST STE 115
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-1447
Mailing Address - Country:US
Mailing Address - Phone:650-347-1247
Mailing Address - Fax:650-348-7025
Practice Address - Street 1:700 S CLAREMONT ST STE 115
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-1447
Practice Address - Country:US
Practice Address - Phone:650-347-1247
Practice Address - Fax:650-348-7025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04222Medicare UPIN
CADC0111850Medicare ID - Type Unspecified