MEDICARE: BRODHEADSVILLE CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor
2	111N00000X	Chiropractor	DC1730L	PA

General Provider Information

NPI Number	:	1124023114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRODHEADSVILLE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	PO BOX 447
Second Line	:	6 PILGRIM WAY
City	:	BRODHEADSVILLE
State	:	PA
Zip	:	18322-0447
Country	:	US
Telephone Number	:	570-992-7626
Fax Number	:	570-992-8759

Provider Business Practice Location Address
First Line	:	6 PILGRIM WAY
Second Line	:
City	:	BRODHEADSVILLE
State	:	PA
Zip	:	18322-0447
Country	:	US
Telephone Number	:	570-992-7626
Fax Number	:	570-992-8759

Authorized Official
Title or Position	:	OWNER CHIROPRACTIC
Name	:	DR. ROBERT JOHN VAN METTER
Credential	:	DC
Telephone Number	:	570-992-7626

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2008

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Directions to “BRODHEADSVILLE CHIROPRACTIC ” Practice Location

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