Provider Demographics
NPI:1245213362
Name:CONSALES, ANTHONY M (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:CONSALES
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 1:3045 JACKS RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131
Mailing Address - Country:US
Mailing Address - Phone:412-678-9123
Mailing Address - Fax:412-678-9127
Practice Address - Street 1:3045 JACKS RUN ROAD
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131
Practice Address - Country:US
Practice Address - Phone:412-678-9123
Practice Address - Fax:412-678-9127
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002199L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
422561K5PMedicare PIN
T30330Medicare UPIN