Provider Demographics
NPI:1871783647
Name:PIZZIRULLI, STEPHANIE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIE
Last Name:PIZZIRULLI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:MOLTHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:131 RUE DE YOE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1355
Mailing Address - Country:US
Mailing Address - Phone:209-529-1519
Mailing Address - Fax:209-529-1598
Practice Address - Street 1:131 RUE DE YOE
Practice Address - Street 2:SUITE A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1355
Practice Address - Country:US
Practice Address - Phone:209-529-1519
Practice Address - Fax:209-529-1598
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0227790Medicare PIN