Provider Demographics
NPI:1760596100
Name:SPOTO, MARIO A (DC, PC)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:A
Last Name:SPOTO
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2941
Mailing Address - Country:US
Mailing Address - Phone:610-269-7662
Mailing Address - Fax:610-873-1255
Practice Address - Street 1:305 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2941
Practice Address - Country:US
Practice Address - Phone:610-269-7662
Practice Address - Fax:610-873-1255
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001967L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0026945000OtherINDEPENDENCE BLUE CROSS
PA51145OtherAETNA
PASPO65339OtherBCBS
PA51145OtherAETNA