Provider Demographics
NPI:1275646671
Name:AMERICAN BACK CENTER LLC
Entity Type:Organization
Organization Name:AMERICAN BACK CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:PEDUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-935-3300
Mailing Address - Street 1:103 BRADFORD RD
Mailing Address - Street 2:BUILDING 2 SUITE 100
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-6910
Mailing Address - Country:US
Mailing Address - Phone:724-935-3300
Mailing Address - Fax:
Practice Address - Street 1:103 BRADFORD RD
Practice Address - Street 2:BUILDING 2 SUITE 100
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-6910
Practice Address - Country:US
Practice Address - Phone:724-935-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1888498OtherHIGHMARK
PA1888498OtherHIGHMARK