Provider Demographics
NPI:1114015591
Name:CANELIAS, PAULINE M (DC)
Entity Type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:M
Last Name:CANELIAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E 40TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0401
Mailing Address - Country:US
Mailing Address - Phone:212-986-4339
Mailing Address - Fax:
Practice Address - Street 1:15 E 40TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0401
Practice Address - Country:US
Practice Address - Phone:212-986-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX00581301111N00000X
MACH1499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO58133BOtherWORKERS' COMP BOARD
NYX47751Medicare ID - Type Unspecified
NYU19911Medicare UPIN