Provider Demographics
NPI:1750374047
Name:MISTRETTA, T DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:T
Middle Name:DAVID
Last Name:MISTRETTA
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 1:175 N BUHL FARM DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-1752
Mailing Address - Country:US
Mailing Address - Phone:724-981-4550
Mailing Address - Fax:
Practice Address - Street 1:175 N BUHL FARM DR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-1752
Practice Address - Country:US
Practice Address - Phone:724-981-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 5160 L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013911780002Medicaid
PA0013911780002Medicaid
MI186446Medicare ID - Type Unspecified