=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770956575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLEASANTVIEW CHIROPRACTIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2015
-----------------------------------------------------
Last Update Date | 11/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 715 E 37TH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16504-1727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-456-4200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 715 E 37TH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16504-1727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-456-4200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, CHIROPRACTOR
-----------------------------------------------------
Name | DR. AMBER A KRIDLER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 814-591-1095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC10279
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------