Basic Information
| Provider Information | |||||||||
| NPI: | 1558697011 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | A.J. DICESARO DC, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 CLAIRTON BLVD. | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128852929 | ||||||||
| FaxNumber: | 4122530619 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 CLAIRTON BLVD. | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128852929 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2009 | ||||||||
| LastUpdateDate: | 03/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | DICESARO | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4128852929 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | D.C. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC006431L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.