Provider Demographics
NPI:1841205408
Name:IANNETTA MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:IANNETTA MEDICAL SERVICES INC
Other - Org Name:IANNETTA CHIROPRACTIC ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER OF CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:IANNETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-564-3120
Mailing Address - Street 1:287 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1221
Mailing Address - Country:US
Mailing Address - Phone:207-564-3120
Mailing Address - Fax:207-564-2909
Practice Address - Street 1:287 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1221
Practice Address - Country:US
Practice Address - Phone:207-564-3120
Practice Address - Fax:207-564-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR549111N00000X
PADC003198R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1195Medicare ID - Type Unspecified