Healthcare Provider Details

I. General information

NPI: 1578744363
Provider Name (Legal Business Name): COLELLA CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WYOMING AVE
WEST PITTSTON PA
18643-2822
US

IV. Provider business mailing address

200 WYOMING AVE
WEST PITTSTON PA
18643-2822
US

V. Phone/Fax

Practice location:
  • Phone: 570-883-2220
  • Fax: 570-883-1922
Mailing address:
  • Phone: 570-883-2220
  • Fax: 570-883-1922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC004645L
License Number StatePA

VIII. Authorized Official

Name: FRANK J COLELLA
Title or Position: OWNER
Credential: DC
Phone: 570-883-2220