Provider Demographics
NPI:1801527809
Name:ANGELILLI, VINCENZO III (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENZO
Middle Name:
Last Name:ANGELILLI
Suffix:III
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 1:1100 BOARDMAN CANFIELD RD APT 53B
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-8060
Mailing Address - Country:US
Mailing Address - Phone:330-550-5275
Mailing Address - Fax:
Practice Address - Street 1:2600 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2807
Practice Address - Country:US
Practice Address - Phone:614-539-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05186111N00000X
OHAPP-000605868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor