Provider Demographics
NPI:1184741480
Name:PETTINATO CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:PETTINATO CHIROPRACTIC CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PETTINATO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-444-6644
Mailing Address - Street 1:5420 WILLIAM FLYNN HWY
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9652
Mailing Address - Country:US
Mailing Address - Phone:724-444-6644
Mailing Address - Fax:
Practice Address - Street 1:5420 WILLIAM FLYNN HWY
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9652
Practice Address - Country:US
Practice Address - Phone:724-444-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006233L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA311810OtherUPMC
PA001614086Medicaid
PA790678OtherBLUE CROSSBLUE SHIELD
PA001614086Medicaid
PA085766Medicare PIN
PA790678OtherBLUE CROSSBLUE SHIELD