Provider Demographics
NPI:1649282047
Name:IONTA, DAVID ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:IONTA
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 1:121 MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:ESPERANCE
Mailing Address - State:NY
Mailing Address - Zip Code:12066
Mailing Address - Country:US
Mailing Address - Phone:518-875-6420
Mailing Address - Fax:518-875-6358
Practice Address - Street 1:121 MAIN ST
Practice Address - Street 2:STE 1
Practice Address - City:ESPERANCE
Practice Address - State:NY
Practice Address - Zip Code:12066
Practice Address - Country:US
Practice Address - Phone:518-875-6420
Practice Address - Fax:518-875-6358
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10034866OtherCDPHP
NY98L110OtherMVP LANDMARK
NYX1F80OtherEMPIRE BLUE CROSS
NYBB7150Medicare ID - Type Unspecified