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General NPI Number Information
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NPI Number | 1699989921
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Entity Type | Organization
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Legal Business Name | IADELUCA CHIROPRACTIC CENTER INC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3721 POPLAR ST
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City | ERIE
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State | PA
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Zip | 16508-2651
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Country | US
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Telephone | 814-864-9775
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Fax | 814-864-7227
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Provider Business Mailing Address
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Address Line | 3721 POPLAR ST
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City | ERIE
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State | PA
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Zip | 16508-2651
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Country | US
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Telephone | 814-864-9775
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Fax | 814-864-7227
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Authorized Official
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Title or Position | CEO - DOCTOR OF CHIROPRACTIC
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Name | DAVID BRIAN IADELUCA
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Credential | DC
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Telephone | 814-864-9775
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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 | DC-007310-L
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License Number State | PA
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