Provider Demographics
NPI:1023877370
Name:BACCELLIERI, CARL JACKSON (DC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:JACKSON
Last Name:BACCELLIERI
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 1:2 WILLOW GREEN LN
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1765
Mailing Address - Country:US
Mailing Address - Phone:484-947-7019
Mailing Address - Fax:
Practice Address - Street 1:226 E STATE ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-3125
Practice Address - Country:US
Practice Address - Phone:610-444-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor