MEDICARE: HEALTHLAND 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	111N00000X	Chiropractor	DC007383L	PA

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	:	1518230093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHLAND CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	1627 FREEPORT RD
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-1447
Country	:	US
Telephone Number	:	724-230-0422
Fax Number	:	724-230-0424

Provider Business Practice Location Address
First Line	:	1627 FREEPORT RD
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-1447
Country	:	US
Telephone Number	:	724-230-0422
Fax Number	:	724-230-0424

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS BLAINE FENNELL JR.
Credential	:	D.C.
Telephone Number	:	724-230-0422

Provider Enumeration Date	:	02/15/2012
Last Update Date	:	02/15/2012

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