Provider Demographics
NPI:1093784076
Name:PARANICH, STEPHEN ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ROBERT
Last Name:PARANICH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518
Mailing Address - Country:US
Mailing Address - Phone:570-451-1122
Mailing Address - Fax:570-451-0541
Practice Address - Street 1:102 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518
Practice Address - Country:US
Practice Address - Phone:570-451-1122
Practice Address - Fax:570-451-0541
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004862L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1263525Medicaid
PA695918OtherBLUE CROSS BLUE SHIELD
PA2513389OtherAETNA
PA805039Other1ST PRIORITY
PA695918KVKMedicare ID - Type Unspecified
PA695918OtherBLUE CROSS BLUE SHIELD