Provider Demographics
NPI:1992840102
Name:IACUONE, KATHERINE CELESTE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:CELESTE
Last Name:IACUONE
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 1:720 E THUNDERBIRD RD
Mailing Address - Street 2:#1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5396
Mailing Address - Country:US
Mailing Address - Phone:602-439-1515
Mailing Address - Fax:
Practice Address - Street 1:720 E THUNDERBIRD RD
Practice Address - Street 2:#1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5396
Practice Address - Country:US
Practice Address - Phone:602-439-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ125291Medicare PIN