Provider Demographics
NPI:1073713988
Name:IANNETTA, JAMES
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:IANNETTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1221
Mailing Address - Country:US
Mailing Address - Phone:207-564-3120
Mailing Address - Fax:207-564-2909
Practice Address - Street 1:287 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1221
Practice Address - Country:US
Practice Address - Phone:207-564-3120
Practice Address - Fax:207-564-2909
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR549111N00000X
PADC003198R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME110590000Medicaid
ME5096254OtherAETNA
ME048001OtherANTHEM
ME5096254OtherAETNA
ME078541Medicare PIN