Provider Demographics
NPI:1528014115
Name:MONTESANO, JOHN ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:MONTESANO
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 1:305 CAMP HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-2604
Mailing Address - Country:US
Mailing Address - Phone:412-469-9600
Mailing Address - Fax:412-469-9901
Practice Address - Street 1:305 CAMP HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2604
Practice Address - Country:US
Practice Address - Phone:412-469-9600
Practice Address - Fax:412-469-9901
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMO1828970OtherHIGHMARK
PA101532733 0001Medicaid
PA102828Q8LMedicare PIN