Provider Demographics
NPI:1417956434
Name:ORTENZIO, JOSEPH ANTHONY JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:ORTENZIO
Suffix:JR
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 1:40 PARK DR
Mailing Address - Street 2:
Mailing Address - City:EAST PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413-1850
Mailing Address - Country:US
Mailing Address - Phone:330-426-9453
Mailing Address - Fax:330-426-6815
Practice Address - Street 1:40 PARK DR
Practice Address - Street 2:
Practice Address - City:EAST PALESTINE
Practice Address - State:OH
Practice Address - Zip Code:44413-1850
Practice Address - Country:US
Practice Address - Phone:330-426-9453
Practice Address - Fax:330-426-6815
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH69111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0207216Medicaid
T46310Medicare UPIN
OH0207216Medicaid