Provider Demographics
NPI:1780875286
Name:CAPUANO, STEPHEN DOMINIC (DC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DOMINIC
Last Name:CAPUANO
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:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-8038
Mailing Address - Country:US
Mailing Address - Phone:610-948-4125
Mailing Address - Fax:610-948-1499
Practice Address - Street 1:368 N LEWIS RD
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1576
Practice Address - Country:US
Practice Address - Phone:610-948-4125
Practice Address - Fax:610-948-1499
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-6902-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor