MEDICARE: HASBROUCK CHIROPRACTIC LLC

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	DC010679	PA

General Provider Information

NPI Number	:	1639562002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HASBROUCK CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	361 WORTH ST
Second Line	:
City	:	CORRY
State	:	PA
Zip	:	16407-1410
Country	:	US
Telephone Number	:	814-664-7041
Fax Number	:	814-664-7042

Provider Business Practice Location Address
First Line	:	361 WORTH ST
Second Line	:
City	:	CORRY
State	:	PA
Zip	:	16407-1410
Country	:	US
Telephone Number	:	814-664-7041
Fax Number	:	814-664-7042

Authorized Official
Title or Position	:	CEO
Name	:	DR. ALLISON HASBROUCK
Credential	:	D.C.
Telephone Number	:	814-664-7041

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	03/10/2015

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