Provider Demographics
NPI:1275679748
Name:CHIROPRACTIC ASSOCIATES OF N.E.P.A PC
Entity Type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF N.E.P.A PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVAVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-558-2225
Mailing Address - Street 1:1789 NORTH KEYSER AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508
Mailing Address - Country:US
Mailing Address - Phone:570-558-2225
Mailing Address - Fax:570-558-2226
Practice Address - Street 1:1789 NORTH KEYSER AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508
Practice Address - Country:US
Practice Address - Phone:570-558-2225
Practice Address - Fax:570-558-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008716111N00000X
PAAJ008700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAST1398226OtherBCBS
PA815091OtherFPH
PAST1398226OtherBCBS
PA059791Medicare PIN