Healthcare Provider Details

I. General information

NPI: 1972590834
Provider Name (Legal Business Name): ANTHONY C YANNESSA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 B S. HAMILTON RD
GAHANNA OH
43230
US

IV. Provider business mailing address

358 B S HAMILTON RD
GAHANNA OH
43230-3311
US

V. Phone/Fax

Practice location:
  • Phone: 614-471-5442
  • Fax: 614-471-5462
Mailing address:
  • Phone: 614-471-5442
  • Fax: 614-471-5462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3253
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: