Provider Demographics
NPI:1295701571
Name:FANELLI, MICHAEL E (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:FANELLI
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 1:33 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-9452
Mailing Address - Country:US
Mailing Address - Phone:856-478-2800
Mailing Address - Fax:856-478-2804
Practice Address - Street 1:33 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-9452
Practice Address - Country:US
Practice Address - Phone:856-478-2800
Practice Address - Fax:856-478-2804
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00407900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
713121Medicare ID - Type Unspecified
U28801Medicare UPIN