Provider Demographics
NPI:1033389937
Name:MAGONE CHIROPRACTIC OFFICE LLC
Entity Type:Organization
Organization Name:MAGONE CHIROPRACTIC OFFICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAGONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-483-3475
Mailing Address - Street 1:100 STOOPS DR STE 250
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-3553
Mailing Address - Country:US
Mailing Address - Phone:724-483-3475
Mailing Address - Fax:724-483-4798
Practice Address - Street 1:100 STOOPS DR STE 250
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-3553
Practice Address - Country:US
Practice Address - Phone:724-483-3475
Practice Address - Fax:724-483-4798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU57479Medicare UPIN