Provider Demographics
NPI:1467444109
Name:STANGO, DEBRA L (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
Last Name:STANGO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 FOX PLAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2706
Mailing Address - Country:US
Mailing Address - Phone:412-372-5900
Mailing Address - Fax:
Practice Address - Street 1:118 FOX PLAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2706
Practice Address - Country:US
Practice Address - Phone:412-372-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007684L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA840406OtherBCBS
PA421671840OtherCOMMERCIAL PAYORS
PA036879Medicare ID - Type UnspecifiedMEDICARE
PAU79801Medicare UPIN
PA421671840OtherCOMMERCIAL PAYORS