MEDICARE: ELK COUNTY CHIROPRACTIC, INC.

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	111NX0800X	Orthopedic Chiropractor	DC002175-L	PA

General Provider Information

NPI Number	:	1235193285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELK COUNTY CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	246 CHESTNUT ST
Second Line	:	P.O. BOX 27
City	:	ST MARYS
State	:	PA
Zip	:	15857-1708
Country	:	US
Telephone Number	:	814-781-7208
Fax Number	:	814-781-8505

Provider Business Practice Location Address
First Line	:	246 CHESTNUT ST
Second Line	:
City	:	ST MARYS
State	:	PA
Zip	:	15857-1708
Country	:	US
Telephone Number	:	814-781-7208
Fax Number	:	814-781-8505

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NEAL LEPOVETSKY
Credential	:	D.C.
Telephone Number	:	814-781-7208

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	08/22/2020

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