=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972033587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCALISE CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12280 STATE ROUTE 30
-----------------------------------------------------
City | NORTH HUNTINGDON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-864-7447
-----------------------------------------------------
Fax | 724-864-8022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12280 STATE ROUTE 30
-----------------------------------------------------
City | NORTH HUNTINGDON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15642-1820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-864-7447
-----------------------------------------------------
Fax | 724-864-8022
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WILLIAM F SCALISE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 724-864-7447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC-5162
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------