Provider Demographics
NPI:1841363835
Name:PORRECA, JOSEPH DOMENICK (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DOMENICK
Last Name:PORRECA
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 1:411 VERNON DR
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:PA
Mailing Address - Zip Code:15089-2802
Mailing Address - Country:US
Mailing Address - Phone:724-929-6077
Mailing Address - Fax:724-929-9410
Practice Address - Street 1:1100 FAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-2304
Practice Address - Country:US
Practice Address - Phone:724-929-6077
Practice Address - Fax:724-929-9410
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003079L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T 30037Medicare UPIN
PAPO188029Medicare ID - Type Unspecified