Provider Demographics
NPI:1992878854
Name:DETONE, JOHN P (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:DETONE
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 1:335 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-1706
Mailing Address - Country:US
Mailing Address - Phone:191-477-9580
Mailing Address - Fax:191-477-9580
Practice Address - Street 1:335 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-1706
Practice Address - Country:US
Practice Address - Phone:191-477-9580
Practice Address - Fax:191-477-9580
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002497-1111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52195Medicare UPIN
NYX15721Medicare ID - Type Unspecified