Provider Demographics
NPI:1790811388
Name:MENICHELLA, MICHELE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LYNN
Last Name:MENICHELLA
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 1:323 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2130
Mailing Address - Country:US
Mailing Address - Phone:718-442-7251
Mailing Address - Fax:718-442-7271
Practice Address - Street 1:323 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2130
Practice Address - Country:US
Practice Address - Phone:718-442-7251
Practice Address - Fax:718-442-7271
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX26401Medicare ID - Type Unspecified
NYT52916Medicare UPIN