Provider Demographics
NPI:1467793372
Name:SCIPIONE, JEFFERY ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:ROBERT
Last Name:SCIPIONE
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 1:2458 PINE HURST CT
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3394
Mailing Address - Country:US
Mailing Address - Phone:814-883-3196
Mailing Address - Fax:
Practice Address - Street 1:1200 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2824
Practice Address - Country:US
Practice Address - Phone:814-237-5559
Practice Address - Fax:814-237-4392
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADC010722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program