Provider Demographics
NPI:1659372779
Name:PONTO, ALBERT R (DC)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:R
Last Name:PONTO
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 1:4670 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:PARKESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19365-1770
Mailing Address - Country:US
Mailing Address - Phone:610-857-5025
Mailing Address - Fax:610-857-9499
Practice Address - Street 1:4670 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:PARKESBURG
Practice Address - State:PA
Practice Address - Zip Code:19365-1770
Practice Address - Country:US
Practice Address - Phone:610-857-5025
Practice Address - Fax:610-857-9499
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002712 L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U60281Medicare UPIN
PA167968Medicare ID - Type Unspecified