Provider Demographics
NPI:1316907256
Name:DALCANTON, JERRALD J (DC)
Entity type:Individual
Prefix:DR
First Name:JERRALD
Middle Name:J
Last Name:DALCANTON
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 1:4120 WILLIAM PENN HWY.
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668
Mailing Address - Country:US
Mailing Address - Phone:724-327-0148
Mailing Address - Fax:724-327-0108
Practice Address - Street 1:4120 WILLIAM PENN HWY.
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668
Practice Address - Country:US
Practice Address - Phone:724-327-0148
Practice Address - Fax:724-327-0108
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA006498L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA839913Medicare PIN