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General NPI Number Information
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NPI Number | 1053831065
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Entity Type | Organization
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Legal Business Name | ROOTS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 302 CASTLE SHANNON BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15234
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Country | US
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Telephone | 586-703-7501
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Fax |
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Provider Business Mailing Address
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Address Line | 302 CASTLE SHANNON BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15234-1404
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Country | US
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Telephone | 412-502-2297
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. THOMAS CENTOFANTI
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Credential | DC
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Telephone | 412-502-2297
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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 |
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License Number State |
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