Provider Demographics
NPI:1114991247
Name:GRETZ PISCIOTTANO, LAUREL (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:
Last Name:GRETZ PISCIOTTANO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LAUREL
Other - Middle Name:
Other - Last Name:GRETZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:701 TECHNOLOGY DR STE 50
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9506
Mailing Address - Country:US
Mailing Address - Phone:724-942-4444
Mailing Address - Fax:724-485-2286
Practice Address - Street 1:701 TECHNOLOGY DR STE 50
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-9506
Practice Address - Country:US
Practice Address - Phone:724-942-4444
Practice Address - Fax:724-485-2286
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC0004148-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA714675N2JMedicare UPIN
U29376Medicare UPIN