Healthcare Provider Details

I. General information

NPI: 1336132299
Provider Name (Legal Business Name): MLPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CRESCENT ST
FRONT ROYAL VA
22630-3328
US

IV. Provider business mailing address

29 CRESCENT ST
FRONT ROYAL VA
22630-3328
US

V. Phone/Fax

Practice location:
  • Phone: 540-635-1270
  • Fax: 540-635-2732
Mailing address:
  • Phone: 540-635-1270
  • Fax: 540-635-2732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1035
License Number StateVA

VIII. Authorized Official

Name: MICHAEL ALLEN PASTERNACK
Title or Position: PRESIDENT
Credential: DC
Phone: 540-635-1270