Dustin Livingston Agnelli, D.C.
Individual provider Active NPI Chiropractor · Tustin, CA
NPI 1962527622 · NPPES record last updated Dec 5, 2014
Key facts
- NPI
- 1962527622
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 30882 (CA)
- Practice address
- 1254 Irvine Blvd
Tustin, CA 92780-3509 - Phone
- (949) 899-4040
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1088 | HI | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1088 | HI | |
| Chiropractor | 111N00000X | 30882 | CA | Yes |
Addresses
Primary practice location
1254 Irvine Blvd
Tustin, CA 92780-3509
Mailing address
1254 Irvine Blvd
Tustin, CA 92780-3509
Phone (949) 899-4040
Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.