Provider Demographics
NPI:1720140932
Name:IANNACCONE, WILLIAM F (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:IANNACCONE
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 1:1513 THIRD AVENUE
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597
Mailing Address - Country:US
Mailing Address - Phone:925-934-6763
Mailing Address - Fax:925-932-8484
Practice Address - Street 1:1513 THIRD AVENUE
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597
Practice Address - Country:US
Practice Address - Phone:925-934-6763
Practice Address - Fax:925-932-8484
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAO9797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor