Provider Demographics
NPI:1801132832
Name:GIANNETTINO CHIROPRACTIC PC
Entity type:Organization
Organization Name:GIANNETTINO CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GIANNETTINO
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:585-255-0198
Mailing Address - Street 1:7133 W MAIN RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-9380
Mailing Address - Country:US
Mailing Address - Phone:716-282-2225
Mailing Address - Fax:716-284-0162
Practice Address - Street 1:2230 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-2330
Practice Address - Country:US
Practice Address - Phone:716-282-2225
Practice Address - Fax:716-284-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty