Provider Demographics
NPI:1639279730
Name:PAGANO, NUNZIO PETER SR (DC)
Entity type:Individual
Prefix:
First Name:NUNZIO
Middle Name:PETER
Last Name:PAGANO
Suffix:SR
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 1:1335 N STATE ROUTE 2
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-2524
Mailing Address - Country:US
Mailing Address - Phone:304-455-6444
Mailing Address - Fax:304-455-6011
Practice Address - Street 1:901 N STATE ROUTE 2
Practice Address - Street 2:STE 1
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-2560
Practice Address - Country:US
Practice Address - Phone:304-455-6444
Practice Address - Fax:304-455-6011
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000190839OtherBCBS
409013775OtherRAILROAD MEDICARE
WV0131287000Medicaid
WV52450OtherUNICARE
WV1025175OtherBRICKSTREET WORKER'S COMP
WV0131287000Medicaid
409013775OtherRAILROAD MEDICARE