Provider Demographics
NPI:1962571851
Name:LANCELLOTTI, MICHELE R (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:R
Last Name:LANCELLOTTI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 ATWOOD AVE
Mailing Address - Street 2:STE 210A
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-435-4999
Mailing Address - Fax:401-434-7772
Practice Address - Street 1:197 TAUNTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-4540
Practice Address - Country:US
Practice Address - Phone:401-435-4999
Practice Address - Fax:401-434-7772
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4400192OtherUNITED HEALTHCARE
RI646696OtherACN GROUP
RI77879OtherBLUE CROSS BLUE SHIELD
RI401255OtherBLUE CHIP
RI401255OtherBLUE CHIP
RI007010553Medicare ID - Type Unspecified