MEDICARE: COLELLA CHIROPRACTIC

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	DC004645L	PA

General Provider Information

NPI Number	:	1578744363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLELLA CHIROPRACTIC

Provider Business Mailing Address
First Line	:	200 WYOMING AVE
Second Line	:
City	:	WEST PITTSTON
State	:	PA
Zip	:	18643-2822
Country	:	US
Telephone Number	:	570-883-2220
Fax Number	:	570-883-1922

Provider Business Practice Location Address
First Line	:	200 WYOMING AVE
Second Line	:
City	:	WEST PITTSTON
State	:	PA
Zip	:	18643-2822
Country	:	US
Telephone Number	:	570-883-2220
Fax Number	:	570-883-1922

Authorized Official
Title or Position	:	OWNER
Name	:	FRANK J COLELLA
Credential	:	DC
Telephone Number	:	570-883-2220

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	11/20/2007

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