Provider Demographics
NPI:1265436646
Name:PANICALI, JOHN (DC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:PANICALI
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 1:420 ROUTE 34 STE 331
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2517
Mailing Address - Country:US
Mailing Address - Phone:732-462-0049
Mailing Address - Fax:718-462-0059
Practice Address - Street 1:420 ROUTE 34 STE 331
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2517
Practice Address - Country:US
Practice Address - Phone:324-620-0497
Practice Address - Fax:324-620-0597
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX4379111N00000X
NJ38MC00428800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC043796WOtherWC
T52774Medicare UPIN
NYC043796WOtherWC