Provider Demographics
NPI:1497791768
Name:AGOSTINO, GINA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:AGOSTINO
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 1:624 SARAH COURT
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-4350
Mailing Address - Country:US
Mailing Address - Phone:724-244-8825
Mailing Address - Fax:
Practice Address - Street 1:2625 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-4350
Practice Address - Country:US
Practice Address - Phone:724-779-0001
Practice Address - Fax:724-779-0003
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor