Provider Demographics
NPI:1093789604
Name:BERETTA, JOHN CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARL
Last Name:BERETTA
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 1:3506 ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1699
Mailing Address - Country:US
Mailing Address - Phone:724-744-0300
Mailing Address - Fax:724-744-0303
Practice Address - Street 1:3506 RTE 130
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642
Practice Address - Country:US
Practice Address - Phone:724-744-0300
Practice Address - Fax:724-744-0303
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005970L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01483430Medicaid
PA531792Medicare PIN
PA01483430Medicaid