MEDICARE: DR. MICHAEL ANTHONY LANCELLOTTI D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DCP00243	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	440421	OTHER	RI	UNITED HEALTHCARE
2	0000003521	OTHER	RI	BCBSRI
3	400742	OTHER	RI	BLUECHIP RI

General Provider Information

NPI Number	:	1427040336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANTHONY LANCELLOTTI D.C.

Provider Business Mailing Address
First Line	:	1637 MINERAL SPRING AVE
Second Line	:	SUITE 201
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-4042
Country	:	US
Telephone Number	:	401-354-5120
Fax Number	:	401-354-5122

Provider Business Practice Location Address
First Line	:	1637 MINERAL SPRING AVE
Second Line	:	SUITE 201
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-4042
Country	:	US
Telephone Number	:	401-354-5120
Fax Number	:	401-354-5122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/08/2007

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