Provider Demographics
NPI:1518448349
Name:PETRARCA, ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:PETRARCA
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 1:2131 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15673-1005
Mailing Address - Country:US
Mailing Address - Phone:724-478-1501
Mailing Address - Fax:724-478-1552
Practice Address - Street 1:2131 RIVER RD
Practice Address - Street 2:
Practice Address - City:NORTH APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15673-1005
Practice Address - Country:US
Practice Address - Phone:724-478-1501
Practice Address - Fax:724-478-1552
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADC0011402OtherNEW DOCTOR