Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC-003212-L | PA |
NPI | 1275538183 |
---|---|
Provider Name | Dr. Jeffrey Frank Cappuccio |
First Address | Moon Twp, PA 15108-3842 |
Second Address | Moon Twp, PA 15108-3842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 01/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1723250/01 | (05) | PA |