1568415610 NPI number — SOUTHWESTERN CHIROPRACTIC CENTER

Table of content: (NPI 1568415610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568415610 NPI number — SOUTHWESTERN CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWESTERN CHIROPRACTIC CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568415610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 N STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAIRTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15025-2245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-233-3600
Provider Business Mailing Address Fax Number:
412-233-3702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 N STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAIRTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15025-2245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-233-3600
Provider Business Practice Location Address Fax Number:
412-233-3702
Provider Enumeration Date:
05/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GIOIA
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-233-3600

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC002241L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0007883850001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 070277 . This is a "HIGHMARK KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5797204 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100345 . This is a "UPMC HEALTH PLAN" identifier . This identifiers is of the category "OTHER".