MEDICARE: DR. ALIVIA SHOOP D.C

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	DC011120	PA

General Provider Information

NPI Number	:	1356709117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALIVIA SHOOP D.C

Provider Business Mailing Address
First Line	:	1704 BROADVIEW BLVD
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2123
Country	:	US
Telephone Number	:	412-736-9990
Fax Number	:

Provider Business Practice Location Address
First Line	:	1704 BROADVIEW BLVD
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2123
Country	:	US
Telephone Number	:	412-736-9990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2016
Last Update Date	:	02/28/2016

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