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General NPI Number Information
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NPI Number | 1811738636
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Entity Type | Organization
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Legal Business Name | 412 HOMETOWN CHIROPRACTIC
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 2407 PENNSYLVANIA AVE STE A
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City | WEST MIFFLIN
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State | PA
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Zip | 15122-3629
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Country | US
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Telephone | 412-480-1607
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Fax |
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Provider Business Mailing Address
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Address Line | 2407 PENNSYLVANIA AVE STE A
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City | WEST MIFFLIN
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State | PA
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Zip | 15122-3629
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Country | US
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Telephone | 412-480-1607
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Fax |
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Authorized Official
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Title or Position | BILLING
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Name | TRICIA SPEICHER
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Credential |
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Telephone | 412-480-1607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number |
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License Number State |
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