Provider Demographics
NPI:1174607915
Name:NACCARATO, ANTHONY LAWRENCE (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:LAWRENCE
Last Name:NACCARATO
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 1:3447 LAKE TAHOE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8911
Mailing Address - Country:US
Mailing Address - Phone:530-541-8855
Mailing Address - Fax:530-541-7335
Practice Address - Street 1:3447 LAKE TAHOE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8911
Practice Address - Country:US
Practice Address - Phone:530-541-8855
Practice Address - Fax:530-541-7335
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0196570Medicare ID - Type Unspecified