Healthcare Provider Details

I. General information

NPI: 1093784076
Provider Name (Legal Business Name): STEPHEN ROBERT PARANICH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N MAIN ST
OLD FORGE PA
18518
US

IV. Provider business mailing address

102 N MAIN ST
OLD FORGE PA
18518
US

V. Phone/Fax

Practice location:
  • Phone: 570-451-1122
  • Fax: 570-451-0541
Mailing address:
  • Phone: 570-451-1122
  • Fax: 570-451-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC004862L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: