Provider Demographics
NPI:1043467848
Name:CHRIS PEECHATKA CORRECTIVE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CHRIS PEECHATKA CORRECTIVE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PEECHATKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-629-6829
Mailing Address - Street 1:3199 ROUTE 611
Mailing Address - Street 2:
Mailing Address - City:BARTONSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18321-7808
Mailing Address - Country:US
Mailing Address - Phone:570-629-6829
Mailing Address - Fax:866-584-6408
Practice Address - Street 1:3199 ROUTE 611
Practice Address - Street 2:
Practice Address - City:BARTONSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18321-7808
Practice Address - Country:US
Practice Address - Phone:570-629-6829
Practice Address - Fax:866-584-6408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 006824L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA598092OtherBLUE CROSS OF NORTHEASTERN PENNSYLVANIA
PA598092OtherHIGHMARK BLUE SHIELD
PA598092OtherFIRST PRIORITY LIFE INSURANCE