Provider Demographics
NPI:1952464067
Name:PETRISKO, THOMAS WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:PETRISKO
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 1:6091 STEUBENVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1336
Mailing Address - Country:US
Mailing Address - Phone:412-787-3320
Mailing Address - Fax:412-494-9579
Practice Address - Street 1:6091 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1336
Practice Address - Country:US
Practice Address - Phone:412-787-3320
Practice Address - Fax:412-494-9579
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002430-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T28562Medicare UPIN
PA099440H1BMedicare PIN