MEDICARE: PENN CENTER CHIROPRACTIC & REHAB PC

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	DC009354	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001669989	OTHER	PA	HIGHMARK BC/BS
2	722970	OTHER	PA	UPMC

General Provider Information

NPI Number	:	1942552823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENN CENTER CHIROPRACTIC & REHAB PC

Provider Business Mailing Address
First Line	:	3424 WILLIAM PENN HWY
Second Line	:	SUITE 168
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-5444
Country	:	US
Telephone Number	:	412-823-2180
Fax Number	:	412-823-6165

Provider Business Practice Location Address
First Line	:	3424 WILLIAM PENN HWY
Second Line	:	SUITE 168
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-5444
Country	:	US
Telephone Number	:	412-823-2180
Fax Number	:	412-823-6165

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. JEREMY BENZ SUCCOP
Credential	:	D.C.
Telephone Number	:	412-823-2180

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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Directions to “PENN CENTER CHIROPRACTIC & REHAB PC ” Practice Location

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