Healthcare Provider Details

I. General information

NPI: 1205024015
Provider Name (Legal Business Name): CHIROPRACTIC CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 W MARKET ST
SCRANTON PA
18508-1241
US

IV. Provider business mailing address

1138 W MARKET ST
SCRANTON PA
18508-1241
US

V. Phone/Fax

Practice location:
  • Phone: 570-343-5949
  • Fax: 570-343-2564
Mailing address:
  • Phone: 570-343-5949
  • Fax: 570-343-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberAJ009652
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009839
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: AMY MARIE VAUGHN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 570-343-5949