Provider Demographics
NPI:1861597940
Name:DIDOMENICO, PHILIP A (DC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:DIDOMENICO
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 1:874 BUTLER ST
Mailing Address - Street 2:STE 1
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15223-1340
Mailing Address - Country:US
Mailing Address - Phone:412-781-3150
Mailing Address - Fax:412-781-3156
Practice Address - Street 1:874 BUTLER ST
Practice Address - Street 2:STE 1
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15223-1340
Practice Address - Country:US
Practice Address - Phone:412-781-3150
Practice Address - Fax:412-781-3156
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007863L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
002269915-003OtherUNITED HEALTHCARE
1038513OtherAMERICAN SPECIALTY HEALTH
7838854OtherCIGNA
813602OtherHIGHMARK
PA1015637760001Medicaid
318753OtherUPMC
7838854OtherCIGNA