Provider Demographics
NPI:1427040336
Name:LANCELLOTTI, MICHAEL ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:LANCELLOTTI
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 1:1637 MINERAL SPRING AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4042
Mailing Address - Country:US
Mailing Address - Phone:401-354-5120
Mailing Address - Fax:401-354-5122
Practice Address - Street 1:1637 MINERAL SPRING AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4042
Practice Address - Country:US
Practice Address - Phone:401-354-5120
Practice Address - Fax:401-354-5122
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI440421OtherUNITED HEALTHCARE
RI0000003521OtherBCBSRI
RI400742OtherBLUECHIP RI
RIP00120380Medicare ID - Type UnspecifiedRAILROAD MEDICARE
RI0000003521OtherBCBSRI