Provider Demographics
NPI:1033216320
Name:CIANCHETTI, JEFFREY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOHN
Last Name:CIANCHETTI
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 1:2119 SAWYER DRIVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304
Mailing Address - Country:US
Mailing Address - Phone:716-731-3100
Mailing Address - Fax:716-731-4343
Practice Address - Street 1:2119 SAWYER DRIVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304
Practice Address - Country:US
Practice Address - Phone:716-731-3100
Practice Address - Fax:716-731-4343
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008193-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008193OtherNYS LICENSE
NY14280BMedicare ID - Type Unspecified
NY008193OtherNYS LICENSE