Healthcare Provider Details

I. General information

NPI: 1609063221
Provider Name (Legal Business Name): 8TH ST FAMILY CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W 8TH ST
WYOMING PA
18644-1607
US

IV. Provider business mailing address

131 W 8TH ST
WYOMING PA
18644-1607
US

V. Phone/Fax

Practice location:
  • Phone: 570-693-9393
  • Fax: 570-693-6178
Mailing address:
  • Phone: 570-693-9393
  • Fax: 570-693-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC004703L
License Number StatePA

VIII. Authorized Official

Name: CYNTHIA M KENNELLY
Title or Position: OWNER
Credential: DC
Phone: 570-693-9393