Provider Demographics
NPI:1669509238
Name:DR. DAVID A SCIORTINO, LTD
Entity Type:Organization
Organization Name:DR. DAVID A SCIORTINO, LTD
Other - Org Name:SCIORTINO CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SCIORTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-522-0042
Mailing Address - Street 1:1701 S FLORISSANT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-1131
Mailing Address - Country:US
Mailing Address - Phone:314-522-0042
Mailing Address - Fax:
Practice Address - Street 1:1701 S FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-1131
Practice Address - Country:US
Practice Address - Phone:314-522-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU83588Medicare UPIN
MO000031876Medicare ID - Type Unspecified