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General NPI Number Information
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NPI Number | 1043376684
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Entity Type | Organization
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Legal Business Name | PROVIDENCE CHIROPRACTIC CLINIC INC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 1637 MINERAL SPRING AVENUE SUITE 201
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904
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Country | US
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Telephone | 401-354-5120
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Fax | 401-354-5122
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Provider Business Mailing Address
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Address Line | 1637 MINERAL SPRING AVENUE SUITE 201
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904
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Country | US
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Telephone | 401-354-5120
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Fax | 401-354-5122
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. MICHAEL ANTHONY LANCELLOTTI
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Credential | DC
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Telephone | 401-354-5120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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