MEDICARE: SHAMOKIN DAM HEALTH CENTER PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	225100000X	Physical Therapist
3	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235284837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAMOKIN DAM HEALTH CENTER PC

Provider Business Mailing Address
First Line	:	3166 NORTH OLD TRAIL
Second Line	:
City	:	SHAMOKIN DAM
State	:	PA
Zip	:	17876-9409
Country	:	US
Telephone Number	:	570-743-4333
Fax Number	:	570-743-6012

Provider Business Practice Location Address
First Line	:	3166 NORTH OLD TRAIL
Second Line	:
City	:	SHAMOKIN DAM
State	:	PA
Zip	:	17876-9409
Country	:	US
Telephone Number	:	570-743-4333
Fax Number	:	570-743-6012

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL J DUNIGAN
Credential	:	DC
Telephone Number	:	570-743-4333

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	05/05/2009

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Directions to “SHAMOKIN DAM HEALTH CENTER PC ” Practice Location

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