Provider Demographics
NPI:1366302408
Name:IANNUZZI, NICHOLAS M
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:M
Last Name:IANNUZZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 INTERVALE AVE
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1032
Mailing Address - Country:US
Mailing Address - Phone:978-774-4468
Mailing Address - Fax:
Practice Address - Street 1:140 COMMONWEALTH AVE STE 208B
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3625
Practice Address - Country:US
Practice Address - Phone:978-774-4468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA--111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor