Provider Demographics
NPI:1518994656
Name:MAIETTA, JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MAIETTA
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 1:6707 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2502
Mailing Address - Country:US
Mailing Address - Phone:708-749-8922
Mailing Address - Fax:
Practice Address - Street 1:6707 26TH ST
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2502
Practice Address - Country:US
Practice Address - Phone:708-749-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364280Medicare ID - Type Unspecified
ILU56901Medicare UPIN