Provider Demographics
NPI:1053831065
Name:ROOTS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ROOTS CHIROPRACTIC LLC
Other - Org Name:ROOTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CENTOFANTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-502-2297
Mailing Address - Street 1:302 CASTLE SHANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1404
Mailing Address - Country:US
Mailing Address - Phone:412-502-2297
Mailing Address - Fax:
Practice Address - Street 1:302 CASTLE SHANNON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234
Practice Address - Country:US
Practice Address - Phone:586-703-7501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty