Provider Demographics
NPI:1073948634
Name:IANNETTA, JACOB JAMES (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:JAMES
Last Name:IANNETTA
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 1:287 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:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor