Provider Demographics
NPI:1801033113
Name:JEANNITON, MICHAEL DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANIEL
Last Name:JEANNITON
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 1:387 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3206
Mailing Address - Country:US
Mailing Address - Phone:917-686-3548
Mailing Address - Fax:
Practice Address - Street 1:790A UNION ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1307
Practice Address - Country:US
Practice Address - Phone:917-686-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor