Provider Demographics
NPI:1457110579
Name:MUCCIOLO, JEANNETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:
Last Name:MUCCIOLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 HILLSBORO PIKE STE 228
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3314
Mailing Address - Country:US
Mailing Address - Phone:615-562-2225
Mailing Address - Fax:
Practice Address - Street 1:4301 HILLSBORO PIKE STE 228
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3314
Practice Address - Country:US
Practice Address - Phone:615-562-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor