Provider Demographics
NPI:1437376753
Name:TOMASETTI, ADAM R (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:R
Last Name:TOMASETTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1867
Mailing Address - Country:US
Mailing Address - Phone:717-285-0001
Mailing Address - Fax:717-285-0021
Practice Address - Street 1:113 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:MOUNTVILLE
Practice Address - State:PA
Practice Address - Zip Code:17554-1867
Practice Address - Country:US
Practice Address - Phone:717-285-0001
Practice Address - Fax:717-285-0021
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0548Medicare ID - Type UnspecifiedCHIROPRACTIC