Healthcare Provider Details

I. General information

NPI: 1063408839
Provider Name (Legal Business Name): MARY ANN HORDESKY-SEDOROVITZ DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ANN MICHELE HORDESKY-SEDOROVITZ D.C.

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GREEN RIDGE ST STE 2
SCRANTON PA
18509-1828
US

IV. Provider business mailing address

627 OHARA ST
SCRANTON PA
18505-3307
US

V. Phone/Fax

Practice location:
  • Phone: 570-780-8438
  • Fax: 570-347-1534
Mailing address:
  • Phone: 570-780-8438
  • Fax: 570-347-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC006921L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7416479
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA HEALTH INS
# 2
Identifier001549229
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUESHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: