Provider Demographics
NPI:1366714883
Name:PISTELLO, JOEL MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:MICHAEL
Last Name:PISTELLO
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 1:3930 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-5166
Mailing Address - Country:US
Mailing Address - Phone:712-276-4325
Mailing Address - Fax:712-276-6033
Practice Address - Street 1:3930 STADIUM DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-5166
Practice Address - Country:US
Practice Address - Phone:712-276-4325
Practice Address - Fax:712-276-6033
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor