Provider Demographics
NPI:1629641055
Name:DEPIETRO CHIROPRACTIC & WELLNESS LLC
Entity Type:Organization
Organization Name:DEPIETRO CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPIETRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-291-4450
Mailing Address - Street 1:1536 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2062
Mailing Address - Country:US
Mailing Address - Phone:570-291-4450
Mailing Address - Fax:570-291-4454
Practice Address - Street 1:1536 MAIN ST
Practice Address - Street 2:1ST FLOOR REAR
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2062
Practice Address - Country:US
Practice Address - Phone:570-291-4450
Practice Address - Fax:570-291-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty