Provider Demographics
NPI:1710376595
Name:PISANELLI, MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:PISANELLI
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 1:148 E AURORA RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2053
Mailing Address - Country:US
Mailing Address - Phone:330-908-0203
Mailing Address - Fax:
Practice Address - Street 1:148 E AURORA RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-2053
Practice Address - Country:US
Practice Address - Phone:330-908-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor