Healthcare Provider Details

I. General information

NPI: 1609827955
Provider Name (Legal Business Name): STEPHEN STRAKA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAIN ST
BLAKELY PA
18447-1232
US

IV. Provider business mailing address

130 MAIN ST
BLAKELY PA
18447-1232
US

V. Phone/Fax

Practice location:
  • Phone: 570-383-4900
  • Fax: 570-383-4901
Mailing address:
  • Phone: 570-383-4900
  • Fax: 570-383-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008716
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: