Healthcare Provider Details

I. General information

NPI: 1235284837
Provider Name (Legal Business Name): SHAMOKIN DAM HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3166 NORTH OLD TRAIL
SHAMOKIN DAM PA
17876-9409
US

IV. Provider business mailing address

3166 NORTH OLD TRAIL
SHAMOKIN DAM PA
17876-9409
US

V. Phone/Fax

Practice location:
  • Phone: 570-743-4333
  • Fax: 570-743-6012
Mailing address:
  • Phone: 570-743-4333
  • Fax: 570-743-6012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J DUNIGAN
Title or Position: PRESIDENT
Credential: DC
Phone: 570-743-4333