Provider Demographics
NPI:1275557050
Name:DECARLO, DURELL L (DC)
Entity Type:Individual
Prefix:DR
First Name:DURELL
Middle Name:L
Last Name:DECARLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:150 WAYLAND SMITH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-2677
Mailing Address - Country:US
Mailing Address - Phone:724-437-8200
Mailing Address - Fax:724-437-6673
Practice Address - Street 1:150 WAYLAND SMITH DR
Practice Address - Street 2:SUITE
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2677
Practice Address - Country:US
Practice Address - Phone:724-437-8200
Practice Address - Fax:724-437-6673
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063288ZB9PMedicare PIN