Provider Demographics
NPI:1063487205
Name:DISANTI, RICHARD W (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:DISANTI
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 1:715 LITTLE DEER CREEK VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLTON
Mailing Address - State:PA
Mailing Address - Zip Code:15076-0064
Mailing Address - Country:US
Mailing Address - Phone:724-265-2100
Mailing Address - Fax:724-265-2122
Practice Address - Street 1:715 LITTLE DEER CREEK VALLEY RD
Practice Address - Street 2:
Practice Address - City:RUSSELLTON
Practice Address - State:PA
Practice Address - Zip Code:15076-0064
Practice Address - Country:US
Practice Address - Phone:724-265-2100
Practice Address - Fax:724-265-2122
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001778L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1501577Medicaid
PA1501577Medicaid