Provider Demographics
NPI:1144217548
Name:DEPIETRO, JAMES S (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:DEPIETRO
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 1:2217 W FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8821
Mailing Address - Country:US
Mailing Address - Phone:740-654-3375
Mailing Address - Fax:
Practice Address - Street 1:2217 W FAIR AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8821
Practice Address - Country:US
Practice Address - Phone:740-654-3375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1555111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114683Medicaid
OH350032426OtherRAILROAD PIN ID
OH0670081Medicare PIN