Provider Demographics
NPI:1164845574
Name:GANEMIAN, ANNIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:GANEMIAN
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 1:160 TAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-4531
Mailing Address - Country:US
Mailing Address - Phone:401-435-2002
Mailing Address - Fax:
Practice Address - Street 1:160 TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-4531
Practice Address - Country:US
Practice Address - Phone:401-435-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor