Provider Demographics
NPI:1679697494
Name:DIPESO, JOSEPH JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:DIPESO
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 1:2404 PLEASANTVILLE ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2099
Mailing Address - Country:US
Mailing Address - Phone:410-803-8480
Mailing Address - Fax:410-803-4840
Practice Address - Street 1:2404 PLEASANTVILLE ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2099
Practice Address - Country:US
Practice Address - Phone:410-803-8480
Practice Address - Fax:410-803-4840
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT421-0001OtherBCBS (FEP & GHMSI)
MDM452OtherBCBS (MD)
MDT421-0001OtherBCBS (FEP & GHMSI)