Provider Demographics
NPI:1629136353
Name:VITALE, JONATHAN H (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:H
Last Name:VITALE
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 1:4678 STATE ROUTE 51
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-4305
Mailing Address - Country:US
Mailing Address - Phone:724-379-6161
Mailing Address - Fax:724-823-0076
Practice Address - Street 1:4678 STATE ROUTE 51
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-4305
Practice Address - Country:US
Practice Address - Phone:724-379-6161
Practice Address - Fax:724-823-0076
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007076L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000076685OtherHIGHMARK BC
PA000076685OtherHIGHMARK BC