Provider Demographics
NPI:1174675847
Name:THE OAKCHUNAS CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:THE OAKCHUNAS CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:OAKCHUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-849-0779
Mailing Address - Street 1:310 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6311
Mailing Address - Country:US
Mailing Address - Phone:610-849-0779
Mailing Address - Fax:610-849-0824
Practice Address - Street 1:310 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6311
Practice Address - Country:US
Practice Address - Phone:610-849-0779
Practice Address - Fax:610-849-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007894L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036582OtherASHN
PAOA1811014OtherBC BS GROUP#
PA2646503000OtherAMERIHEALTH
PA2646503000OtherIBX
PA2646503000OtherPERSONAL CHOICE
PA7104793OtherAETNA
PA2646503000OtherKEYSTONE
PA50056463OtherCAPITAL BC
PA100259Medicare ID - Type UnspecifiedMEDICARE GROUP #