Provider Demographics
NPI:1083810741
Name:PRO ADJUSTER-AUSTINTOWN INC
Entity Type:Organization
Organization Name:PRO ADJUSTER-AUSTINTOWN INC
Other - Org Name:AUSTINTOWN CHIROPRACTIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PETRALLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-793-0711
Mailing Address - Street 1:4241 KIRK RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-1839
Mailing Address - Country:US
Mailing Address - Phone:330-793-0711
Mailing Address - Fax:
Practice Address - Street 1:4241 KIRK RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-1839
Practice Address - Country:US
Practice Address - Phone:330-793-0711
Practice Address - Fax:330-793-9419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6602130001Medicare NSC