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General NPI Number Information
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NPI Number | 1124023114
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Entity Type | Organization
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Legal Business Name | BRODHEADSVILLE CHIROPRACTIC
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 6 PILGRIM WAY
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322-0447
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Country | US
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Telephone | 570-992-7626
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Fax | 570-992-8759
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Provider Business Mailing Address
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Address Line | PO BOX 447 6 PILGRIM WAY
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322-0447
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Country | US
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Telephone | 570-992-7626
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Fax | 570-992-8759
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Authorized Official
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Title or Position | OWNER CHIROPRACTIC
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Name | DR. ROBERT JOHN VAN METTER
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Credential | DC
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Telephone | 570-992-7626
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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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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC1730L
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License Number State | PA
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