Healthcare Provider Details

I. General information

NPI: 1578565495
Provider Name (Legal Business Name): ROGER V SCANLAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N CENTER ST
EBENSBURG PA
15931-1169
US

IV. Provider business mailing address

1000 N CENTER ST
EBENSBURG PA
15931-1169
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-8130
  • Fax: 814-472-4928
Mailing address:
  • Phone: 814-472-8130
  • Fax: 814-472-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC003049L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: