Provider Demographics
NPI:1639126634
Name:MINUTO, MARK VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:VINCENT
Last Name:MINUTO
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 1:3908 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUNHALL
Mailing Address - State:PA
Mailing Address - Zip Code:15120-3255
Mailing Address - Country:US
Mailing Address - Phone:412-462-2909
Mailing Address - Fax:412-462-9490
Practice Address - Street 1:3908 MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNHALL
Practice Address - State:PA
Practice Address - Zip Code:15120-3255
Practice Address - Country:US
Practice Address - Phone:412-462-2909
Practice Address - Fax:412-462-9490
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003393L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA508085OtherHIGHMARK BC/BS
PA304713OtherUPMC HEALTH PLAN
PA508285Medicare ID - Type Unspecified