Provider Demographics
NPI:1629137559
Name:MARIO A. GRIPPA
Entity Type:Organization
Organization Name:MARIO A. GRIPPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRIPPA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-775-1002
Mailing Address - Street 1:373 VIRGINIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074
Mailing Address - Country:US
Mailing Address - Phone:724-775-1002
Mailing Address - Fax:724-775-2527
Practice Address - Street 1:373 VIRGINIA AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074
Practice Address - Country:US
Practice Address - Phone:724-775-1002
Practice Address - Fax:724-775-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004847L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012780270002Medicaid
PA5356108OtherAETNA PPO
PA1010014OtherGATEWAY
664633OtherUNITED HEALTHCARE
PA9983002OtherCIGNA
PA3087535OtherAETMA HMO
PA00711340Medicare ID - Type Unspecified
PA0012780270002Medicaid