Provider Demographics
NPI:1457451478
Name:DEPASQUA, JOHN CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARL
Last Name:DEPASQUA
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 1:100 FORD DR
Mailing Address - Street 2:STE 10
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-9403
Mailing Address - Country:US
Mailing Address - Phone:724-357-9030
Mailing Address - Fax:724-357-9031
Practice Address - Street 1:100 FORD DR
Practice Address - Street 2:STE 10
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-9403
Practice Address - Country:US
Practice Address - Phone:724-357-9030
Practice Address - Fax:724-357-9031
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007309L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1878880Medicaid
1035216OtherAMERICAN SPECIALTY HEALTH
412038115OtherAETNA
7653207OtherCIGNA
PA1378553OtherHIGHMARK
PA1035216OtherHEALTH AMERICA
PA20476Medicare ID - Type Unspecified