Provider Demographics
NPI:1336170364
Name:IAQUINTO, JOSEPH GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GERARD
Last Name:IAQUINTO
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 1:82 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1716
Mailing Address - Country:US
Mailing Address - Phone:570-724-2255
Mailing Address - Fax:570-723-5110
Practice Address - Street 1:82 EAST AVE
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1716
Practice Address - Country:US
Practice Address - Phone:570-724-2255
Practice Address - Fax:570-723-5110
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC0002800L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0065357000OtherPERSONAL CHOICE
PA1606227OtherBC/BS
PA000969120 0002Medicaid
PA819020OtherFIRST PRIORITY
PA819020OtherFIRST PRIORITY