Provider Demographics
NPI:1578572582
Name:UNETICH, CONNIE S (DC)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:S
Last Name:UNETICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:S
Other - Last Name:MAHOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:621 LONG ROAD
Mailing Address - Street 2:
Mailing Address - City:PENN HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4306
Mailing Address - Country:US
Mailing Address - Phone:412-856-0400
Mailing Address - Fax:412-242-2243
Practice Address - Street 1:621 LONG ROAD
Practice Address - Street 2:
Practice Address - City:PENN HILLS
Practice Address - State:PA
Practice Address - Zip Code:15235-4306
Practice Address - Country:US
Practice Address - Phone:412-856-0400
Practice Address - Fax:412-242-2243
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007154L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2096282OtherAETNA
PA01701412Medicaid
976351OtherHIGHMARK BCBS
2096282OtherAETNA
U72290Medicare UPIN