Healthcare Provider Details

I. General information

NPI: 1811738636
Provider Name (Legal Business Name): 412 HOMETOWN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 PENNSYLVANIA AVE STE A
WEST MIFFLIN PA
15122-3629
US

IV. Provider business mailing address

2407 PENNSYLVANIA AVE STE A
WEST MIFFLIN PA
15122-3629
US

V. Phone/Fax

Practice location:
  • Phone: 412-480-1607
  • Fax:
Mailing address:
  • Phone: 412-480-1607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: TRICIA SPEICHER
Title or Position: BILLING
Credential:
Phone: 412-480-1607