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General NPI Number Information
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NPI Number | 1003847260
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Entity Type | Organization
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Legal Business Name | MT JACKSON CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 500 MT JACKSON ROAD
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City | NEW CASTLE
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State | PA
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Zip | 16102-2618
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Country | US
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Telephone | 724-667-7160
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Fax | 724-667-8807
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Provider Business Mailing Address
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Address Line | 500 MT JACKSON ROAD
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City | NEW CASTLE
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State | PA
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Zip | 16102-2618
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Country | US
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Telephone | 724-667-7160
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Fax | 724-667-8807
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | MR. DAVID E HOSAFLOOK
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Credential | D.C.
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Telephone | 724-667-7160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC004657L
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License Number State | PA
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