Provider Demographics
NPI:1972525442
Name:DEFILIPPO, MARK A (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:DEFILIPPO
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 1:2127 LARKINS WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2014
Mailing Address - Country:US
Mailing Address - Phone:412-716-1490
Mailing Address - Fax:412-381-0267
Practice Address - Street 1:1310 E CARSON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1510
Practice Address - Country:US
Practice Address - Phone:412-716-1490
Practice Address - Fax:412-381-0267
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADE1545746OtherBC/BS
PADE1545746OtherBC/BS