Provider Demographics
NPI:1609957331
Name:PINENO, ANTHONY ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ANDREW
Last Name:PINENO
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 1:808 W SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446
Mailing Address - Country:US
Mailing Address - Phone:215-855-5250
Mailing Address - Fax:215-855-5260
Practice Address - Street 1:850 S VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-4261
Practice Address - Country:US
Practice Address - Phone:215-855-5250
Practice Address - Fax:215-855-5260
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005539-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU54483Medicare UPIN
PA618694SWUMedicare ID - Type Unspecified