Provider Demographics
NPI:1326030057
Name:FEBBRARO, DOMENIC (DC)
Entity Type:Individual
Prefix:DR
First Name:DOMENIC
Middle Name:
Last Name:FEBBRARO
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 1:4091 ROUTE 8
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-3001
Mailing Address - Country:US
Mailing Address - Phone:412-492-4088
Mailing Address - Fax:
Practice Address - Street 1:4091 ROUTE 8
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-3001
Practice Address - Country:US
Practice Address - Phone:412-492-4088
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC65000L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA868043OtherBCBS
PAU61639Medicare UPIN
PA868043OtherBCBS