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NPI Code Detail

MEDICARE: ERIE SPINE & SPORT LLC

MEDICARE: ERIE SPINE & SPORT 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
1111N00000XChiropractorDC011208PA

General Provider Information

NPI Number : 1922547025
Entity Type Code : Organization
Provider Name (Legal Business Name) : ERIE SPINE & SPORT LLC
Provider Business Mailing Address
First Line : 1009 E 38TH ST
Second Line :
City : ERIE
State : PA
Zip : 16504-1843
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1009 E 38TH ST
Second Line :
City : ERIE
State : PA
Zip : 16504-1843
Country : US
Telephone Number : 814-602-3833
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CRAIG BANISZEWSKI
Credential : D.C
Telephone Number : 814-602-3833
Provider Enumeration Date : 02/22/2017
Last Update Date : 06/20/2017

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Directions to “ERIE SPINE & SPORT LLC ” Practice Location

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