Provider Demographics
NPI:1275115552
Name:IADELUCA CHIROPRACTIC CENTER CORRY PC
Entity Type:Organization
Organization Name:IADELUCA CHIROPRACTIC CENTER CORRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:IADELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-459-2580
Mailing Address - Street 1:2921 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2501
Mailing Address - Country:US
Mailing Address - Phone:814-459-2580
Mailing Address - Fax:814-459-2584
Practice Address - Street 1:110 E COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1340
Practice Address - Country:US
Practice Address - Phone:814-336-3434
Practice Address - Fax:814-459-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty