Provider Demographics
NPI:1710971973
Name:CAPUANO, JOHN THOMAS JR (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:CAPUANO
Suffix:JR
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 1:10680 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:N HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2048
Mailing Address - Country:US
Mailing Address - Phone:724-861-9455
Mailing Address - Fax:724-861-9456
Practice Address - Street 1:10680 ROUTE 30
Practice Address - Street 2:
Practice Address - City:N HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2048
Practice Address - Country:US
Practice Address - Phone:724-861-9455
Practice Address - Fax:724-861-9456
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008010L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU93893Medicare UPIN
PA067052Medicare PIN