Provider Demographics
NPI:1144744251
Name:PINNACLE PHYSICAL MEDICINE, LLC
Entity Type:Organization
Organization Name:PINNACLE PHYSICAL MEDICINE, LLC
Other - Org Name:CHIROPRACTIC CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCORT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-223-9700
Mailing Address - Street 1:24 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3335
Mailing Address - Country:US
Mailing Address - Phone:724-884-7902
Mailing Address - Fax:
Practice Address - Street 1:24 WILSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3335
Practice Address - Country:US
Practice Address - Phone:724-884-7902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV01010Medicaid