Provider Demographics
NPI:1639297559
Name:JANNELLI, LINDA A (DC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:A
Last Name:JANNELLI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 N EL CAMINO REAL
Mailing Address - Street 2:STE 205
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5362
Mailing Address - Country:US
Mailing Address - Phone:760-634-3701
Mailing Address - Fax:760-632-9468
Practice Address - Street 1:191 N EL CAMINO REAL
Practice Address - Street 2:STE 205
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5362
Practice Address - Country:US
Practice Address - Phone:760-634-3701
Practice Address - Fax:760-632-9468
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU55276Medicare UPIN