Provider Demographics
NPI:1679553341
Name:COLASURDO, ANTHONY P (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:COLASURDO
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 1:229 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-1529
Mailing Address - Country:US
Mailing Address - Phone:610-282-2525
Mailing Address - Fax:610-282-3372
Practice Address - Street 1:229 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-1529
Practice Address - Country:US
Practice Address - Phone:610-282-2525
Practice Address - Fax:610-282-3372
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006858L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
901524OtherPTAN
PAU67144Medicare UPIN