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General NPI Number Information
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NPI Number | 1144212242
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Entity Type | Individual
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Provider Name | JOHN RICHARD MISHOCK MPT DC
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 1806 SWAMP PIKE SUITE 100
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City | GILBERTSVILLE
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State | PA
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Zip | 19525-9307
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Country | US
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Telephone | 610-327-2600
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Fax | 610-327-9050
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Provider Business Mailing Address
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Address Line | 1806 SWAMP PIKE SUITE 100
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City | GILBERTSVILLE
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State | PA
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Zip | 19525-9307
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Country | US
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Telephone | 610-327-2600
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Fax | 610-327-9050
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC006576L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT012572L
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License Number State | PA
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