1184718066 NPI number — DEFFIBAUGH CHIROPRACTIC, INC.

Table of content: SAVANNA SMITH PT, DPT (NPI 1912663527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184718066 NPI number — DEFFIBAUGH CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEFFIBAUGH CHIROPRACTIC, INC.
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:
6
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:
1184718066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 487
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSTERBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16667-0487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-276-3212
Provider Business Mailing Address Fax Number:
814-276-9254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 OSTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSTERBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-276-3212
Provider Business Practice Location Address Fax Number:
814-276-9253
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEFFIBAUGH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
IRVIN
Authorized Official Title or Position:
PRESIDENT,/OWNER
Authorized Official Telephone Number:
814-276-3212

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC003223L , 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: 0010623490003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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