Provider Demographics
NPI:1972650117
Name:IANNELLI, HEATHER M (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:M
Last Name:IANNELLI
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 ASHWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FT. WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011
Mailing Address - Country:US
Mailing Address - Phone:859-331-8000
Mailing Address - Fax:
Practice Address - Street 1:1856 ASHWOOD CIR
Practice Address - Street 2:
Practice Address - City:FT. WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011
Practice Address - Country:US
Practice Address - Phone:859-331-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1906901Medicare ID - Type Unspecified