Healthcare Provider Details

I. General information

NPI: 1942694617
Provider Name (Legal Business Name): MJAM CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 LUZERNE AVE STE 160
WEST PITTSTON PA
18643-2800
US

IV. Provider business mailing address

16 LUZERNE AVE STE 160
WEST PITTSTON PA
18643-2800
US

V. Phone/Fax

Practice location:
  • Phone: 570-569-2582
  • Fax: 570-569-2584
Mailing address:
  • Phone: 570-569-2582
  • Fax: 570-569-2584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberDC011003
License Number StatePA

VIII. Authorized Official

Name: DR. MATTHEW JOHN MORGAN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 570-569-2582