Provider Demographics
NPI:1851369078
Name:DEPIETROPAOLO, JASON MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:DEPIETROPAOLO
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 1:19 CAREY LN
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3225
Mailing Address - Country:US
Mailing Address - Phone:570-655-8887
Mailing Address - Fax:570-457-1279
Practice Address - Street 1:520 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1542
Practice Address - Country:US
Practice Address - Phone:570-457-0977
Practice Address - Fax:570-457-1279
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007551-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA720512OtherBLUE SHIELD
PA0018139920001Medicaid
PAU81062Medicare UPIN
PA720512OtherBLUE SHIELD