Healthcare Provider Details

I. General information

NPI: 1639126634
Provider Name (Legal Business Name): MARK VINCENT MINUTO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3908 MAIN ST
MUNHALL PA
15120-3255
US

IV. Provider business mailing address

3908 MAIN ST
MUNHALL PA
15120-3255
US

V. Phone/Fax

Practice location:
  • Phone: 412-462-2909
  • Fax: 412-462-9490
Mailing address:
  • Phone: 412-462-2909
  • Fax: 412-462-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC003393L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: