Healthcare Provider Details

I. General information

NPI: 1245217595
Provider Name (Legal Business Name): PAUL RAYMOND MAHLER JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 WYOMING AVE
FORTY FORT PA
18704-4015
US

IV. Provider business mailing address

1144 WYOMING AVE
FORTY FORT PA
18704-4015
US

V. Phone/Fax

Practice location:
  • Phone: 570-283-1610
  • Fax: 570-338-6974
Mailing address:
  • Phone: 570-283-1610
  • Fax: 570-338-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008627
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: