Provider Demographics
NPI:1700199635
Name:SHIPPBOCCARA, CYNTHIA LYNN (DC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:SHIPPBOCCARA
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 1:350 E 17TH ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3231
Mailing Address - Country:US
Mailing Address - Phone:619-847-3378
Mailing Address - Fax:
Practice Address - Street 1:350 E 17TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3231
Practice Address - Country:US
Practice Address - Phone:619-847-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor