Provider Demographics
NPI:1780693069
Name:PISANO, ANGELO (DC)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:PISANO
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 1:3431 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-5641
Mailing Address - Country:US
Mailing Address - Phone:602-548-1998
Mailing Address - Fax:602-547-1480
Practice Address - Street 1:3431 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 9
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-5641
Practice Address - Country:US
Practice Address - Phone:602-548-1998
Practice Address - Fax:602-547-1480
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ76210Medicare ID - Type Unspecified