Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC002723L | PA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | DC002723L | PA |
NPI | 1245230929 |
---|---|
Provider Name | Dr. Richard S Capacio |
First Address | Wayne, PA 19087-2358 |
Second Address | Philadelphia, PA 19148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 11/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01131437 | (05) | PA |
271474 | BLUE CROSS BLUE SHIELD (01) | PA |
U18197 | (02) | PA |