Healthcare Provider Details

I. General information

NPI: 1982917449
Provider Name (Legal Business Name): SOUTH HILLS SPINE AND EXTREMITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 LIBRARY RD
BETHEL PARK PA
15102-2946
US

IV. Provider business mailing address

4880 LIBRARY RD
BETHEL PARK PA
15102-2946
US

V. Phone/Fax

Practice location:
  • Phone: 518-605-4879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberDC010294
License Number StatePA

VIII. Authorized Official

Name: DR. JONATHAN DAVID ABEL
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 518-605-4879