MEDICARE: PROGRESSIVE CHIROPRACTIC CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC009899	PA

General Provider Information

NPI Number	:	1235396672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE CHIROPRACTIC CENTER, LLC

Provider Business Mailing Address
First Line	:	7686 W RIDGE RD
Second Line	:	P.O. BOX 369
City	:	FAIRVIEW
State	:	PA
Zip	:	16415-1074
Country	:	US
Telephone Number	:	814-474-5588
Fax Number	:	814-474-5589

Provider Business Practice Location Address
First Line	:	7686 W RIDGE RD
Second Line	:
City	:	FAIRVIEW
State	:	PA
Zip	:	16415-1074
Country	:	US
Telephone Number	:	814-474-5588
Fax Number	:	814-474-5589

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	PHOEBE K KUTTERNA
Credential	:	D.C.
Telephone Number	:	814-474-5588

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	06/23/2008

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