Healthcare Provider Details

I. General information

NPI: 1255454294
Provider Name (Legal Business Name): UNIVERSITY ORTHOPEDICS CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 ROLLING RIDGE DR
STATE COLLEGE PA
16801-7639
US

IV. Provider business mailing address

101 REGENT CT
STATE COLLEGE PA
16801
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-2101
  • Fax: 814-231-8569
Mailing address:
  • Phone: 814-231-2101
  • Fax: 814-231-8569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1726299
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK # CHIROPRACTICS

VIII. Authorized Official

Name: DAVID J DAVIES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 814-231-2101