=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154629822
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALANK CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2011
-----------------------------------------------------
Last Update Date | 10/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1304 MAIN ST
-----------------------------------------------------
City | HELLERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18055-1323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-838-6891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1304 MAIN ST
-----------------------------------------------------
City | HELLERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18055-1323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-838-6891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRAD PALANK
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 610-838-6891
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC010382
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------