Provider Demographics
NPI:1063475457
Name:PANTALONE, JOHN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:PANTALONE
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 1:267 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-1423
Mailing Address - Country:US
Mailing Address - Phone:717-566-2567
Mailing Address - Fax:717-566-2597
Practice Address - Street 1:267 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-1423
Practice Address - Country:US
Practice Address - Phone:717-566-2567
Practice Address - Fax:717-566-2597
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL2203111N00000X
PA2203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA404710Medicare ID - Type UnspecifiedMEDICARE PROVIDER #