Provider Demographics
NPI:1740573906
Name:IANNETTA MANIPULATION LLC
Entity Type:Organization
Organization Name:IANNETTA MANIPULATION LLC
Other - Org Name:IANNETTA OSTEOPATHIC MANIPULATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:J
Authorized Official - Last Name:IANNETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-883-1003
Mailing Address - Street 1:632 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9794
Mailing Address - Country:US
Mailing Address - Phone:207-883-1003
Mailing Address - Fax:207-883-5322
Practice Address - Street 1:632 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9794
Practice Address - Country:US
Practice Address - Phone:207-883-1003
Practice Address - Fax:207-883-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1897261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty