Healthcare Provider Details

I. General information

NPI: 1144212242
Provider Name (Legal Business Name): JOHN RICHARD MISHOCK MPT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 SWAMP PIKE SUITE 100
GILBERTSVILLE PA
19525-9307
US

IV. Provider business mailing address

1806 SWAMP PIKE SUITE 100
GILBERTSVILLE PA
19525-9307
US

V. Phone/Fax

Practice location:
  • Phone: 610-327-2600
  • Fax: 610-327-9050
Mailing address:
  • Phone: 610-327-2600
  • Fax: 610-327-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC006576L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012572L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: