Provider Demographics
NPI:1114127065
Name:POOLE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:POOLE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:M
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-455-5893
Mailing Address - Street 1:45 SUNBURST DR
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-9481
Mailing Address - Country:US
Mailing Address - Phone:570-455-5893
Mailing Address - Fax:570-459-5756
Practice Address - Street 1:45 SUNBURST DR
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-9481
Practice Address - Country:US
Practice Address - Phone:570-455-5893
Practice Address - Fax:570-459-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001991L PA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center