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General NPI Number Information
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NPI Number | 1013258151
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Entity Type | Organization
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Legal Business Name | HEALTHWAYS CHIROPRACTIC PC
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Dates
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Enumeration Date | 03/14/2013
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 4125 W RIDGE RD
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City | ERIE
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State | PA
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Zip | 16506-1763
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Country | US
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Telephone | 814-833-9355
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Fax | 814-833-9355
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Provider Business Mailing Address
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Address Line | 4125 W RIDGE RD
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City | ERIE
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State | PA
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Zip | 16506-1763
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Country | US
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Telephone | 814-833-9355
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Fax | 814-833-9355
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Authorized Official
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Title or Position | OWNER/ DOCTOR
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Name | DR. ERIC SETH MIZUBA
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Credential | DC
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Telephone | 814-833-9355
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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 | DC007380L
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License Number State | PA
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