Provider Demographics
NPI:1477612000
Name:SPENNETTA, JAMES ADDISON (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ADDISON
Last Name:SPENNETTA
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 1:6810 WATTS RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1393
Mailing Address - Country:US
Mailing Address - Phone:608-273-2225
Mailing Address - Fax:608-273-1684
Practice Address - Street 1:6810 WATTS RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1393
Practice Address - Country:US
Practice Address - Phone:608-273-2225
Practice Address - Fax:608-273-1684
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38862500Medicaid
WI38862500Medicaid