MEDICARE: PROGRESSIVE CHIROPRACTIC & INJURY CTR, PC

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	DC004658L	PA

General Provider Information

NPI Number	:	1225068976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE CHIROPRACTIC & INJURY CTR, PC

Provider Business Mailing Address
First Line	:	PO BOX 369
Second Line	:
City	:	FAIRVIEW
State	:	PA
Zip	:	16415-0369
Country	:	US
Telephone Number	:	814-474-5588
Fax Number	:	814-474-5589

Provider Business Practice Location Address
First Line	:	7686 W RIDGE RD
Second Line	:
City	:	FAIRVIEW
State	:	PA
Zip	:	16415-1074
Country	:	US
Telephone Number	:	814-474-5588
Fax Number	:	814-474-5589

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIMOTHY GERARD MANNINO
Credential	:	D.C.
Telephone Number	:	814-474-5588

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/22/2020

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