Provider Demographics
NPI:1164520441
Name:DISABATINO, DOMINICK G (DC)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:G
Last Name:DISABATINO
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 1:6 DICKINSON DR
Mailing Address - Street 2:BLDG. 100 SUITE 108
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9689
Mailing Address - Country:US
Mailing Address - Phone:610-459-0300
Mailing Address - Fax:610-459-1556
Practice Address - Street 1:6 DICKINSON DR
Practice Address - Street 2:BLDG. 100 SUITE 108
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9689
Practice Address - Country:US
Practice Address - Phone:610-459-0300
Practice Address - Fax:610-459-1556
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003605L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
033914Medicare PIN