Provider Demographics
NPI:1821659210
Name:LANCELLOTTI, JOSHUA R (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:R
Last Name:LANCELLOTTI
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 1:1524 ATWOOD AVE STE 210A
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-455-0291
Mailing Address - Fax:401-455-0294
Practice Address - Street 1:1524 ATWOOD AVE STE 210A
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-274-9355
Practice Address - Fax:401-455-0290
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty