Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC009169 | PA |
N | 111NN1001X | Nutrition | DC009169 | PA |
NPI | 1417096561 |
---|---|
Provider Name | Dr. Jean Dagostino |
First Address | Bethlehem, PA 18016-1121 |
Second Address | Allentown, PA 18106-9345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U99594 | (02) | PA |