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General NPI Number Information
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NPI Number | 1942552823
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Entity Type | Organization
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Legal Business Name | PENN CENTER CHIROPRACTIC & REHAB PC
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 3424 WILLIAM PENN HWY SUITE 168
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City | PITTSBURGH
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State | PA
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Zip | 15235-5444
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Country | US
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Telephone | 412-823-2180
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Fax | 412-823-6165
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Provider Business Mailing Address
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Address Line | 3424 WILLIAM PENN HWY SUITE 168
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City | PITTSBURGH
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State | PA
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Zip | 15235-5444
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Country | US
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Telephone | 412-823-2180
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Fax | 412-823-6165
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JEREMY BENZ SUCCOP
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Credential | D.C.
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Telephone | 412-823-2180
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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 | DC009354
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License Number State | PA
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