Provider Demographics
NPI:1447433024
Name:CURCURUTO, MIA L (DC)
Entity type:Individual
Prefix:DR
First Name:MIA
Middle Name:L
Last Name:CURCURUTO
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 1:5901 CHRISTIE AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1930
Mailing Address - Country:US
Mailing Address - Phone:510-579-7074
Mailing Address - Fax:
Practice Address - Street 1:5901 CHRISTIE AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1930
Practice Address - Country:US
Practice Address - Phone:510-579-7074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor