1780860916 NPI number — STEEL CITY FAMILY CHIROPRACTIC, LLC

Table of content: (NPI 1780860916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780860916 NPI number — STEEL CITY FAMILY CHIROPRACTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEEL CITY FAMILY CHIROPRACTIC, LLC
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:
1780860916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
389 PINEVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15037-9406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
281 TRI COUNTY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLE VERNON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15012-1989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-720-7464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RACZKOWSKI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
412-720-7464

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC009884 , 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: 2011000 . This is a "BCBS PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".