Provider Demographics
NPI:1750379483
Name:TRAMONTIN, JACQUELINE (DC)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:TRAMONTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1310
Mailing Address - Country:US
Mailing Address - Phone:610-966-2726
Mailing Address - Fax:484-214-0195
Practice Address - Street 1:173 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1310
Practice Address - Country:US
Practice Address - Phone:610-966-2726
Practice Address - Fax:484-214-0195
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005188L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU42078Medicare UPIN