Provider Demographics
NPI:1306850110
Name:PACIENZA, PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:PACIENZA
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 1:621 W MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1017
Mailing Address - Country:US
Mailing Address - Phone:724-238-6920
Mailing Address - Fax:724-238-6940
Practice Address - Street 1:621 W MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1017
Practice Address - Country:US
Practice Address - Phone:724-238-6920
Practice Address - Fax:724-238-6940
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor