Provider Demographics
NPI:1982692562
Name:GRIGUOLI, ANTHONY ROCCO (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ROCCO
Last Name:GRIGUOLI
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 1:1109 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-2616
Mailing Address - Country:US
Mailing Address - Phone:570-455-4811
Mailing Address - Fax:570-455-5331
Practice Address - Street 1:1109 W 15TH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-2616
Practice Address - Country:US
Practice Address - Phone:570-455-4811
Practice Address - Fax:570-455-5331
Is Sole Proprietor?:No
Enumeration Date:2005-10-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006502L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor