Provider Demographics
NPI:1467422998
Name:PISCIOTTANO, GENO A (DC)
Entity Type:Individual
Prefix:
First Name:GENO
Middle Name:A
Last Name:PISCIOTTANO
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 1:1001 CORPORATE DR
Mailing Address - Street 2:STE 120
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-8551
Mailing Address - Country:US
Mailing Address - Phone:724-743-4500
Mailing Address - Fax:724-743-4501
Practice Address - Street 1:1001 CORPORATE DR
Practice Address - Street 2:STE 120
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-8551
Practice Address - Country:US
Practice Address - Phone:724-743-4500
Practice Address - Fax:724-743-4501
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006881L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU71616Medicare UPIN
PA014208Medicare ID - Type Unspecified