Provider Demographics
NPI:1649787607
Name:PAGE, BIANCA M (DC)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:M
Last Name:PAGE
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 1:5080 CAMINO DEL ARROYO APT 571
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3191
Mailing Address - Country:US
Mailing Address - Phone:858-609-9019
Mailing Address - Fax:
Practice Address - Street 1:5080 CAMINO DEL ARROYO APT 571
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3191
Practice Address - Country:US
Practice Address - Phone:858-609-9019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor