Provider Demographics
NPI:1144494782
Name:ABSOLUTE BACK AND HEALTH CENTER DC PC
Entity type:Organization
Organization Name:ABSOLUTE BACK AND HEALTH CENTER DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:412-751-6601
Mailing Address - Street 1:100 MCLAY DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-2362
Mailing Address - Country:US
Mailing Address - Phone:412-751-6601
Mailing Address - Fax:412-751-6603
Practice Address - Street 1:100 MCLAY DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-2362
Practice Address - Country:US
Practice Address - Phone:412-751-6601
Practice Address - Fax:412-751-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008987111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA651314OtherUNITED HEALTHCARE
PA001646760OtherBLUE CROSS BLUE SHIELD
PAP0000914OtherUNITED RAILROAD
PA1040680OtherAMERICAN SPECIALTY NETWORK
PA322175OtherUPMC
PA1538137OtherGATEWAY
PA5006597OtherCIGNA
PA001967676Medicaid
PA416725OtherHEALTH ASSURANCE/HEALTH AMERICA
PA7909778OtherAETNA
PA001967676Medicaid
PA651314OtherUNITED HEALTHCARE