Individual
JEROME DIBACCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
725 YOKUM ST, ELKINS, WV 26241-3353
(304) 636-3232
Mailing address
725 YOKUM ST, ELKINS, WV 26241-3353
(304) 636-3232
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/27/2020
Last updated
10/27/2020
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