Provider Demographics
NPI:1659357077
Name:DISALVATORE, THOMAS D (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:DISALVATORE
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 1:1956 W PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6424
Mailing Address - Country:US
Mailing Address - Phone:440-992-0160
Mailing Address - Fax:440-998-0121
Practice Address - Street 1:1956 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6424
Practice Address - Country:US
Practice Address - Phone:440-992-0160
Practice Address - Fax:440-998-0121
Is Sole Proprietor?:No
Enumeration Date:2005-12-17
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000121103OtherANTHEM
OH0958414Medicaid
OHDI0755843Medicare ID - Type Unspecified