=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467734293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRAFICANTE FAMILY CHIROPRACTIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2011
-----------------------------------------------------
Last Update Date | 11/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3010 MAPLE AVE
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16601-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-940-8888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3010 MAPLE AVE
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16601-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-940-8888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. BRANDON MICHAEL TRAFICANTE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 814-940-8888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------