Provider Demographics
NPI:1235101353
Name:SCIPIONE, JOHN L (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:SCIPIONE
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 1:905 W BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2811
Mailing Address - Country:US
Mailing Address - Phone:814-238-0250
Mailing Address - Fax:
Practice Address - Street 1:905 W BEAVER AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2811
Practice Address - Country:US
Practice Address - Phone:814-238-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007725L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA036439X02Medicare PIN
PAU79551Medicare UPIN