Provider Demographics
NPI:1649561275
Name:PRENETA, MICHAEL ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:PRENETA
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 1:610 TEN ROD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4236
Mailing Address - Country:US
Mailing Address - Phone:401-295-9786
Mailing Address - Fax:
Practice Address - Street 1:610 TEN ROD RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4236
Practice Address - Country:US
Practice Address - Phone:401-295-9786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-30
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor