Provider Demographics
NPI:1205834595
Name:DAMICO, LOUIS DUANE (DC)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:DUANE
Last Name:DAMICO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:LOUIS
Other - Middle Name:DUANE
Other - Last Name:DAMICO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2401 DARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1324
Mailing Address - Country:US
Mailing Address - Phone:724-843-7255
Mailing Address - Fax:724-843-2254
Practice Address - Street 1:2401 DARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1324
Practice Address - Country:US
Practice Address - Phone:724-843-7255
Practice Address - Fax:724-843-2254
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006255L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016110100001Medicaid
PA794252Medicare PIN
794252Medicare ID - Type Unspecified
PA0016110100001Medicaid