Provider Demographics
NPI:1447787015
Name:VANNICOLA, JOSEPH LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEE
Last Name:VANNICOLA
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 1:755 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-5447
Mailing Address - Country:US
Mailing Address - Phone:785-393-5309
Mailing Address - Fax:
Practice Address - Street 1:2749 PEMBROOK PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-7482
Practice Address - Country:US
Practice Address - Phone:785-537-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor