Provider Demographics
NPI:1235183518
Name:CLIFFORD FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:CLIFFORD FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-222-5040
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:CLIFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18413-0009
Mailing Address - Country:US
Mailing Address - Phone:570-555-4070
Mailing Address - Fax:
Practice Address - Street 1:MT VIEW PLAZA
Practice Address - Street 2:SUITE 3
Practice Address - City:CLIFFORD
Practice Address - State:PA
Practice Address - Zip Code:18413-0009
Practice Address - Country:US
Practice Address - Phone:570-555-4070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007559L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
087036Medicare ID - Type Unspecified