John Carl Beretta, DC
Individual provider Active NPI Chiropractor · Irwin, PA
NPI 1093789604 · NPPES record last updated May 11, 2011
Key facts
- NPI
- 1093789604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- DC005970L (PA)
- Practice address
- 3506 Rte 130
Irwin, PA 15642 - Phone
- (724) 744-0300
- Fax
- (724) 744-0303
- NPI assigned
- Feb 13, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC005970L | PA | Yes |
Addresses
Primary practice location
3506 Rte 130
Irwin, PA 15642
Mailing address
3506 Route 130
Irwin, PA 15642-1699
Phone (724) 744-0300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01483430 | Medicaid | PA |
Other providers in Irwin, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.