MEDICARE: CLEMENTE CHIROPRACTIC CLINIC

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

General Provider Information

NPI Number	:	1275658163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEMENTE CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	829 JEFFERSON AVE
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-3822
Country	:	US
Telephone Number	:	724-223-8223
Fax Number	:

Provider Business Practice Location Address
First Line	:	829 JEFFERSON AVE
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-3822
Country	:	US
Telephone Number	:	724-223-8223
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK A. CLEMENTE
Credential	:	DC
Telephone Number	:	724-223-8223

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	08/22/2020

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