Provider Demographics
NPI:1144322207
Name:BAFILE, JOSEPH VITO JR (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VITO
Last Name:BAFILE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5650
Mailing Address - Country:US
Mailing Address - Phone:570-454-2474
Mailing Address - Fax:570-454-0097
Practice Address - Street 1:1749 E BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5650
Practice Address - Country:US
Practice Address - Phone:570-454-2474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007795L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018778550001Medicaid
PA049345SUHMedicare ID - Type Unspecified
U85875Medicare UPIN