Healthcare Provider Details

I. General information

NPI: 1730106345
Provider Name (Legal Business Name): PENN CENTER CHIROPRACTIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 WM PENN HWY SUITE 168
PITTSBURGH PA
15235
US

IV. Provider business mailing address

3424 WM PENN HWY SUITE 168
PITTSBURGH PA
15235
US

V. Phone/Fax

Practice location:
  • Phone: 412-823-2180
  • Fax: 412-823-6165
Mailing address:
  • Phone: 412-823-2180
  • Fax: 412-823-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC006365L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberAJ006365L
License Number StatePA

VIII. Authorized Official

Name: DR. JULIA ANNE BERTOLINE
Title or Position: OWNER
Credential:
Phone: 412-823-2180