Provider Demographics
NPI:1417178351
Name:ANNICELLI, MICHAEL RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:ANNICELLI
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 1:361 5TH AVE
Mailing Address - Street 2:CHIROPRACTIC CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3398
Mailing Address - Country:US
Mailing Address - Phone:718-965-2100
Mailing Address - Fax:718-965-2333
Practice Address - Street 1:361 5TH AVE
Practice Address - Street 2:CHIROPRACTIC CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3398
Practice Address - Country:US
Practice Address - Phone:718-965-2100
Practice Address - Fax:718-965-2333
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor