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General NPI Number Information
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NPI Number | 1619694486
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Entity Type | Organization
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Legal Business Name | DIPETTA CHIROPRACTIC CLINIC PLLC
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 2 CHENOWETH DR STE D
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City | BRIDGEPORT
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State | WV
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Zip | 26330-0257
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Country | US
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Telephone | 304-376-9792
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Fax |
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Provider Business Mailing Address
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Address Line | 109 CARRIAGE LN
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1346
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Country | US
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Telephone | 304-376-9792
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | SUSAN DIPETTA
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Credential | DC
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Telephone | 304-376-9792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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