Healthcare Provider Details
I. General information
NPI: 1790793172
Provider Name (Legal Business Name): PAMMER CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/03/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1104 6TH ST
CATASAUQUA PA
18032-2210
US
IV. Provider business mailing address
1104 6TH ST
CATASAUQUA PA
18032-2210
US
V. Phone/Fax
- Phone: 610-264-3344
- Fax: 610-264-2081
- Phone: 610-264-3344
- Fax: 610-264-2081
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | 004888L |
| License Number State | PA |
VIII. Authorized Official
Name: DR.
JOHN
C
PAMMER
III
Title or Position: CHIROPRACTOR
Credential: D.C,
Phone: 610-264-3344