Provider Demographics
NPI:1770038218
Name:IANNUCCILLI, GIANCARLO
Entity Type:Individual
Prefix:DR
First Name:GIANCARLO
Middle Name:
Last Name:IANNUCCILLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1836
Mailing Address - Country:US
Mailing Address - Phone:401-421-1125
Mailing Address - Fax:401-421-3951
Practice Address - Street 1:560 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1836
Practice Address - Country:US
Practice Address - Phone:401-421-1125
Practice Address - Fax:401-421-3951
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor