Provider Demographics
NPI:1194752212
Name:CIRCELLI, ANDY (DC)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:
Last Name:CIRCELLI
Suffix:
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 1:971 US HIGHWAY 202 N
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3757
Mailing Address - Country:US
Mailing Address - Phone:908-252-1600
Mailing Address - Fax:
Practice Address - Street 1:971 US HIGHWAY 202 N
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3757
Practice Address - Country:US
Practice Address - Phone:908-252-1600
Practice Address - Fax:908-252-0100
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3016414OtherOXFORD
NJP3016414OtherOXFORD