Individual provider Active NPI

Damien Peter Ciasullo, DC

  • Chiropractor
  • Philadelphia, PA
National Provider Identifier
1871505792
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
008019 Issued in PA
Practice address
6809 Germantown Ave
Philadelphia, PA 19119-2112
Phone
(215) 844-4400
Fax
(215) 844-4070
NPI assigned
Aug 12, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 008019 PA Primary

Addresses

Primary practice location

6809 Germantown Ave
Philadelphia, PA 19119-2112

Mailing address

6809 Germantown Ave
Philadelphia, PA 19119-2112
Phone (215) 844-4400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
008019PAMDChiropractor

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871505792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6809 GERMANTOWN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191192112",
            "telephone_number": "215-844-4400",
            "fax_number": "215-844-4070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6809 GERMANTOWN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191192112",
            "telephone_number": "215-844-4400",
            "fax_number": "215-844-4070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIASULLO",
        "first_name": "DAMIEN",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "008019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.