Provider Demographics
NPI:1801943089
Name:PREVENTIVE MEDICINE, PC
Entity type:Organization
Organization Name:PREVENTIVE MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:PINTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-254-1400
Mailing Address - Street 1:212 W EDISON RD STE B
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8301
Mailing Address - Country:US
Mailing Address - Phone:574-254-1400
Mailing Address - Fax:574-254-1650
Practice Address - Street 1:212 W EDISON RD STE B
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8301
Practice Address - Country:US
Practice Address - Phone:574-254-1400
Practice Address - Fax:574-254-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN239350Medicare ID - Type Unspecified