Provider Demographics
NPI:1205024015
Name:CHIROPRACTIC CARE CENTER
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-343-5949
Mailing Address - Street 1:1138 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1241
Mailing Address - Country:US
Mailing Address - Phone:570-343-5949
Mailing Address - Fax:570-343-2564
Practice Address - Street 1:1138 W MARKET ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1241
Practice Address - Country:US
Practice Address - Phone:570-343-5949
Practice Address - Fax:570-343-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009839111N00000X
PAAJ009652111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty