Healthcare Provider Details

I. General information

NPI: 1578721635
Provider Name (Legal Business Name): BENTLEYVILLE CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 JOHNSTON RD
BENTLEYVILLE PA
15314-1104
US

IV. Provider business mailing address

104 JOHNSTON RD P.O. BOX 194
BENTLEYVILLE PA
15314-1104
US

V. Phone/Fax

Practice location:
  • Phone: 724-239-2225
  • Fax: 724-239-2250
Mailing address:
  • Phone: 724-239-2225
  • Fax: 724-239-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberPA005528L
License Number StatePA

VIII. Authorized Official

Name: DR. BRIAN SCOTT HASCHETS
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 724-239-2225