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NPI Code Detail

MEDICARE: MR. JOHN RICHARD MISHOCK MPT DC

MEDICARE:  MR. JOHN RICHARD MISHOCK  MPT DC
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
1111N00000XChiropractorDC006576LPA
2225100000XPhysical TherapistPT012572LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11962428391OTHERPAGROUP NPI
2694511OTHERPAHIGHMARK
3MI506229OTHERPADC-HIGHMARK
40449992000OTHERPAKEYSTONE HEALTH PLAN EAST
50264322000OTHERPADC-KHPE
60264322000OTHERPADC-PERSONAL CHOICE
738300034OTHERPADC-AETNA
80449992000OTHERPAPERSONAL CHOICE

General Provider Information

NPI Number : 1144212242
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN RICHARD MISHOCK MPT DC
Provider Business Mailing Address
First Line : 1806 SWAMP PIKE
Second Line : SUITE 100
City : GILBERTSVILLE
State : PA
Zip : 19525-9307
Country : US
Telephone Number : 610-327-2600
Fax Number : 610-327-9050
Provider Business Practice Location Address
First Line : 1806 SWAMP PIKE
Second Line : SUITE 100
City : GILBERTSVILLE
State : PA
Zip : 19525-9307
Country : US
Telephone Number : 610-327-2600
Fax Number : 610-327-9050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 03/17/2008

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Directions to “ MR. JOHN RICHARD MISHOCK MPT DC” Practice Location

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