Provider Demographics
NPI:1851416457
Name:PACELLI, ANTHONY J (DC, CCN)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:PACELLI
Suffix:
Gender:M
Credentials:DC, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5152
Mailing Address - Country:US
Mailing Address - Phone:765-448-7222
Mailing Address - Fax:765-447-7051
Practice Address - Street 1:40 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5152
Practice Address - Country:US
Practice Address - Phone:765-448-7222
Practice Address - Fax:765-447-7051
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT35054Medicare UPIN
IN807280AMedicare ID - Type Unspecified