Provider Demographics
NPI:1417224445
Name:TINNIRELLO, PIETRO (DC)
Entity Type:Individual
Prefix:DR
First Name:PIETRO
Middle Name:
Last Name:TINNIRELLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:PIETRO
Other - Middle Name:
Other - Last Name:TINNIRELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2827 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2825
Mailing Address - Country:US
Mailing Address - Phone:708-317-9191
Mailing Address - Fax:
Practice Address - Street 1:2827 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2825
Practice Address - Country:US
Practice Address - Phone:708-317-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor