Provider Demographics
NPI:1730192535
Name:DEMINICO, EUGENE RINALDI (DC)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:RINALDI
Last Name:DEMINICO
Suffix:
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 1:84 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1713
Mailing Address - Country:US
Mailing Address - Phone:570-654-0036
Mailing Address - Fax:570-654-7890
Practice Address - Street 1:84 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1713
Practice Address - Country:US
Practice Address - Phone:570-654-0036
Practice Address - Fax:570-654-7890
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001908L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006310910001Medicaid
PA0006310910001Medicaid
PA087409Medicare ID - Type Unspecified