Provider Demographics
NPI:1558402396
Name:LINSKEY FERENTINO, NICOLE J (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:J
Last Name:LINSKEY FERENTINO
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 1:3002 N TWP BLVD
Mailing Address - Street 2:PITTSTON TWP
Mailing Address - City:PITTSTON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18640
Mailing Address - Country:US
Mailing Address - Phone:570-602-1590
Mailing Address - Fax:570-602-1592
Practice Address - Street 1:3002 N TWP BLVD
Practice Address - Street 2:PITTSTON TWP
Practice Address - City:PITTSTON TWP
Practice Address - State:PA
Practice Address - Zip Code:18640
Practice Address - Country:US
Practice Address - Phone:570-602-1590
Practice Address - Fax:570-602-1592
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U90598Medicare ID - Type Unspecified
300067326Medicare UPIN