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General NPI Number Information
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NPI Number | 1871563619
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Entity Type | Organization
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Legal Business Name | TEJAN CHIROPRACTIC INC
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 4012 JORDAN STREET, BOX 420
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City | SOUTH HEIGHTS
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State | PA
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Zip | 15081-0420
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Country | US
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Telephone | 724-375-5534
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Fax | 724-375-5575
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Provider Business Mailing Address
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Address Line | 4012 JORDAN STREET, BOX 420
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City | SOUTH HEIGHTS
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State | PA
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Zip | 15081-0420
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Country | US
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Telephone | 724-375-5534
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Fax | 724-375-5575
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK S TEJAN
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Credential | DC
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Telephone | 724-375-5534
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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 | DC003643L
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License Number State | PA
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