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General NPI Number Information
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NPI Number | 1548531734
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Entity Type | Organization
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Legal Business Name | TRIFECTA CHIROPRACTIC AND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 820 S MAIN ST STE 1B
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City | GREENSBURG
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State | PA
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Zip | 15601-4139
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Country | US
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Telephone | 724-832-6700
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Fax | 724-832-6711
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Provider Business Mailing Address
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Address Line | 820 S MAIN ST STE 1B
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City | GREENSBURG
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State | PA
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Zip | 15601-4139
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Country | US
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Telephone | 724-832-6700
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Fax | 724-832-6711
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC/SINGLE MEMBE
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Name | DR. TIMOTHY PATRICK FETTER
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Credential | D.C.
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Telephone | 724-832-6700
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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 | DC010456
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License Number State | PA
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