Healthcare Provider Details

I. General information

NPI: 1275679748
Provider Name (Legal Business Name): CHIROPRACTIC ASSOCIATES OF N.E.P.A PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1789 NORTH KEYSER AVENUE SUITE 1
SCRANTON PA
18508
US

IV. Provider business mailing address

1789 NORTH KEYSER AVENUE SUITE 1
SCRANTON PA
18508
US

V. Phone/Fax

Practice location:
  • Phone: 570-558-2225
  • Fax: 570-558-2226
Mailing address:
  • Phone: 570-558-2225
  • Fax: 570-558-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008716
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberAJ008700
License Number StatePA

VIII. Authorized Official

Name: MS. KATHY RAVAVICH
Title or Position: OFFICE MANAGER
Credential:
Phone: 570-558-2225