Provider Demographics
NPI:1689603078
Name:SANTIAGO, JOANNE ANDRE' (DC)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:ANDRE'
Last Name:SANTIAGO
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 1:549 W AVON RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2909
Mailing Address - Country:US
Mailing Address - Phone:860-673-2225
Mailing Address - Fax:
Practice Address - Street 1:549 W AVON RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2909
Practice Address - Country:US
Practice Address - Phone:860-673-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT259CT111N00000X, 111NS0005X
CT00259111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00410622Medicaid
350000306Medicare ID - Type Unspecified
CT00410622Medicaid