Provider Demographics
NPI:1255414116
Name:SPINELLI, CARL MICHAEL II (DC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:MICHAEL
Last Name:SPINELLI
Suffix:II
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 1:1310 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3010
Mailing Address - Country:US
Mailing Address - Phone:973-338-5577
Mailing Address - Fax:973-338-7113
Practice Address - Street 1:1310 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3010
Practice Address - Country:US
Practice Address - Phone:973-338-5577
Practice Address - Fax:973-338-7113
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO2393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ502493Medicare ID - Type UnspecifiedCHIROPRACTOR