Provider Demographics
NPI:1134281157
Name:SIGNORIELLO, JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:SIGNORIELLO
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:PO BOX 415
Mailing Address - Street 2:36 NEW HAVEN ROAD
Mailing Address - City:SYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3406
Mailing Address - Country:US
Mailing Address - Phone:203-888-7246
Mailing Address - Fax:203-888-6490
Practice Address - Street 1:36 NEW HAVEN ROAD
Practice Address - Street 2:
Practice Address - City:SYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-3406
Practice Address - Country:US
Practice Address - Phone:203-888-7246
Practice Address - Fax:203-888-6490
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4404205OtherUHC
050000506CT02OtherBLUE CROSS
CT4127595Medicaid
T87587Medicare UPIN