Provider Demographics
NPI:1497882088
Name:SCIORTINO, DAVID ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:SCIORTINO
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 1:1701 S FLORISSANT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-1131
Mailing Address - Country:US
Mailing Address - Phone:314-522-0042
Mailing Address - Fax:314-521-8629
Practice Address - Street 1:1701 S FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-1131
Practice Address - Country:US
Practice Address - Phone:314-522-0042
Practice Address - Fax:314-521-8629
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU83588Medicare UPIN