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General NPI Number Information
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NPI Number | 1558825489
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Entity Type | Individual
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Provider Name | JERRELL JOHN HARDISON DC
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Gender | Male
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 9000 PERRY HWY
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City | PITTSBURGH
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State | PA
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Zip | 15237-5367
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Country | US
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Telephone | 412-367-2165
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Fax | 412-367-2183
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Provider Business Mailing Address
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Address Line | 544 CRAIGHEAD ST APT D
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City | CANONSBURG
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State | PA
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Zip | 15317-1746
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Country | US
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Telephone | 814-244-1009
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC011451
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License Number State | PA
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