Healthcare Provider Details

I. General information

NPI: 1295810687
Provider Name (Legal Business Name): NITTANY VALLEY CHIROPRACTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 UNIVERSITY DR 214
STATE COLLEGE PA
16801-6552
US

IV. Provider business mailing address

611 UNIVERSITY DR 214
STATE COLLEGE PA
16801-6552
US

V. Phone/Fax

Practice location:
  • Phone: 814-234-5271
  • Fax: 814-234-9730
Mailing address:
  • Phone: 814-234-5271
  • Fax: 814-234-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC03147
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. CYNTHIA CORNISH LOVE
Title or Position: OFFICE MANAGER
Credential:
Phone: 814-234-5271