=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285798710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 07/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 BENNER PIKE
-----------------------------------------------------
City | STATE COLLEGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16801-7317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-237-2225
-----------------------------------------------------
Fax | 814-237-2520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 BENNER PIKE
-----------------------------------------------------
City | STATE COLLEGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16801-7317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-237-2225
-----------------------------------------------------
Fax | 814-237-2520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER-CHIROPRACTOR
-----------------------------------------------------
Name | DR. DAVID D PASSARELLI
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 814-237-2225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------