Provider Demographics
NPI:1144208166
Name:MAINIERO, JOHN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:MAINIERO
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 1:1420 SOUTH LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361
Mailing Address - Country:US
Mailing Address - Phone:856-691-5900
Mailing Address - Fax:856-691-3801
Practice Address - Street 1:1420 SOUTH LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361
Practice Address - Country:US
Practice Address - Phone:856-691-5900
Practice Address - Fax:856-691-3801
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00473400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA736045OtherAETNA
NJ1D6669409Medicaid
NJ1D6669409Medicaid