Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC004959L | PA |
N | 111NN1001X | Nutrition | DC004959L | PA |
NPI | 1225182694 |
---|---|
Provider Name | Dr. John Salvatore Barbagallo JR. |
First Address | Newton, WV 25266-9402 |
Second Address | West Chester, PA 19382-8412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 20/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U34573 | (02) | PA |