Provider Demographics
NPI:1417097296
Name:CAMELLI, ANDRE J (DC)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:J
Last Name:CAMELLI
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 1:1980 NILES CORTLAND RD NE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9405
Mailing Address - Country:US
Mailing Address - Phone:330-609-0355
Mailing Address - Fax:330-609-0335
Practice Address - Street 1:1980 NILES CORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9405
Practice Address - Country:US
Practice Address - Phone:330-609-0355
Practice Address - Fax:330-609-0335
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC.3115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4181311Medicare PIN