Provider Demographics
NPI:1275056830
Name:LUBRANO, ANTONIO (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:LUBRANO
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 1:912 DARBY RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4608
Mailing Address - Country:US
Mailing Address - Phone:610-446-4808
Mailing Address - Fax:610-446-7020
Practice Address - Street 1:912 DARBY RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4608
Practice Address - Country:US
Practice Address - Phone:301-758-0887
Practice Address - Fax:610-446-4808
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD$$$$$$$$$Medicaid