Provider Demographics
NPI:1275034332
Name:PYATETSKY FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PYATETSKY FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER / CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PYATETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-854-1383
Mailing Address - Street 1:863 N BUHL FARM DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-1557
Mailing Address - Country:US
Mailing Address - Phone:724-854-1383
Mailing Address - Fax:
Practice Address - Street 1:1790 N HERMITAGE RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-6624
Practice Address - Country:US
Practice Address - Phone:724-962-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty