Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC1583L | PA |
NPI | 1518928852 |
---|---|
Provider Name | Dr. Charles Thomas Statti |
First Address | Moon Township, PA 15108-2653 |
Second Address | Moon Township, PA 15108-2653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 08/07/2007 |