Provider Demographics
NPI:1194780122
Name:DEPIETRO, ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DEPIETRO
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 1:1536 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2062
Mailing Address - Country:US
Mailing Address - Phone:570-291-4450
Mailing Address - Fax:570-291-4454
Practice Address - Street 1:1536 MAIN ST
Practice Address - Street 2:1ST FLOOR REAR
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2062
Practice Address - Country:US
Practice Address - Phone:570-291-4450
Practice Address - Fax:570-291-4454
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001998704OtherBLUE CARE
PA20045679OtherAMERIHEALTH
PA001998704OtherBLUE CARE HMO (FPH)
PA101168716-0001Medicaid
PA1058062/7225529OtherAETNA
PA1194780122OtherGHP FAMILY
PA854450OtherOPTUM-UHC
PAP00315312OtherRAILROAD MEDICARE
PA78572-1067OtherGEISINGER