MEDICARE: PORT ALLEGANY 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

General Provider Information

NPI Number	:	1972195832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT ALLEGANY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	717 E MILL ST
Second Line	:
City	:	PORT ALLEGANY
State	:	PA
Zip	:	16743-9743
Country	:	US
Telephone Number	:	814-642-7236
Fax Number	:	814-313-7535

Provider Business Practice Location Address
First Line	:	717 E MILL ST
Second Line	:
City	:	PORT ALLEGANY
State	:	PA
Zip	:	16743-9743
Country	:	US
Telephone Number	:	814-642-7236
Fax Number	:	814-313-7535

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW M YOUNG
Credential	:	DC
Telephone Number	:	716-307-7904

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	02/10/2021

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