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General NPI Number Information
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NPI Number | 1366944456
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Entity Type | Organization
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Legal Business Name | CONVENIENT CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 03/05/2018
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Provider Practice Location Address
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Address Line | 2021 CLAY PIKE
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City | IRWIN
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State | PA
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Zip | 15642-6319
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Country | US
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Telephone | 724-515-5599
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Fax | 724-592-5154
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Provider Business Mailing Address
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Address Line | 2021 CLAY PIKE
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City | IRWIN
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State | PA
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Zip | 15642-6319
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Country | US
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Telephone | 724-515-5599
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Fax | 724-592-5154
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN GROSS
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Credential | DC
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Telephone | 724-515-5599
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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 | DC011272
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License Number State | PA
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