Provider Demographics
NPI:1801894852
Name:DIVITO, THOMAS A (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:DIVITO
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 1:44 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1627
Mailing Address - Country:US
Mailing Address - Phone:330-757-4029
Mailing Address - Fax:330-757-9192
Practice Address - Street 1:44 N MAIN ST
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1627
Practice Address - Country:US
Practice Address - Phone:330-757-4029
Practice Address - Fax:330-757-9192
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU13424Medicare UPIN
OHDI0675031Medicare ID - Type Unspecified