Provider Demographics
NPI:1669577649
Name:JANNELLI, RICHARD M (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:JANNELLI
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 1:1 BENTON CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810
Mailing Address - Country:US
Mailing Address - Phone:302-475-9226
Mailing Address - Fax:302-475-4215
Practice Address - Street 1:1 BENTON CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810
Practice Address - Country:US
Practice Address - Phone:302-475-9226
Practice Address - Fax:302-475-4215
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000284111N00000X
PADC005113L111N00000X
NJ38MC00397900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
607318OtherINDEPENDENCE BLUE CROSS
0004406423OtherAETNA
607318OtherHIGH MARK BLUE SHIELD