Provider Demographics
NPI:1528000767
Name:AIELLO, JERRY (DC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:AIELLO
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 1:605 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2201
Mailing Address - Country:US
Mailing Address - Phone:248-542-4314
Mailing Address - Fax:248-542-5414
Practice Address - Street 1:605 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2201
Practice Address - Country:US
Practice Address - Phone:248-542-4314
Practice Address - Fax:248-542-5414
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF35218Medicare ID - Type Unspecified