Provider Demographics
NPI:1417944679
Name:CLEMENTE, ANNETTE MARICE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:MARICE
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ANNETTE
Other - Middle Name:MARICE
Other - Last Name:CLEMENTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1971 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2639
Mailing Address - Country:US
Mailing Address - Phone:724-222-5232
Mailing Address - Fax:724-225-5141
Practice Address - Street 1:1971 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2639
Practice Address - Country:US
Practice Address - Phone:724-222-5232
Practice Address - Fax:724-225-5141
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006834-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA505865Medicare ID - Type Unspecified
PA68399Medicare UPIN