Provider Demographics
NPI:1588722904
Name:VILLELLA, JAY (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:VILLELLA
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 1:1301 W LANE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3514
Mailing Address - Country:US
Mailing Address - Phone:614-486-3950
Mailing Address - Fax:614-486-3960
Practice Address - Street 1:1301 W LANE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3514
Practice Address - Country:US
Practice Address - Phone:614-486-3950
Practice Address - Fax:614-486-3960
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH223860528027Medicaid
OH223860528027Medicaid
OHVI4064552Medicare PIN