Provider Demographics
NPI:1013075340
Name:CALLACI, JULIANO (DC)
Entity Type:Individual
Prefix:
First Name:JULIANO
Middle Name:
Last Name:CALLACI
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 1:716 CAPITOLA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2777
Mailing Address - Country:US
Mailing Address - Phone:831-479-1213
Mailing Address - Fax:831-479-1016
Practice Address - Street 1:716 CAPITOLA AVE STE A
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2777
Practice Address - Country:US
Practice Address - Phone:831-479-1213
Practice Address - Fax:831-479-1016
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0277270OtherPTAN