Provider Demographics
NPI:1275690661
Name:MISTRETTA, JOHN PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:MISTRETTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GREENVILLE ORTHOPEDIC CTR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1210
Mailing Address - Country:US
Mailing Address - Phone:724-588-3939
Mailing Address - Fax:724-588-6313
Practice Address - Street 1:5 GREENVILLE ORTHOPEDIC CTR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1210
Practice Address - Country:US
Practice Address - Phone:724-588-3939
Practice Address - Fax:724-588-6313
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003842L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMI1825671OtherHIGHMARK BLUE SHIELD
PAM1056940Medicare ID - Type UnspecifiedMEDICARE
PA251859060Medicare UPIN