Provider Demographics
NPI:1285844654
Name:JIM THORPE SPINAL REHABILITATION INC.
Entity Type:Organization
Organization Name:JIM THORPE SPINAL REHABILITATION INC.
Other - Org Name:CARBON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SKRIMCOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-325-2991
Mailing Address - Street 1:811 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-2207
Mailing Address - Country:US
Mailing Address - Phone:570-325-2991
Mailing Address - Fax:570-325-2991
Practice Address - Street 1:811 CENTER ST
Practice Address - Street 2:
Practice Address - City:JIM THORPE
Practice Address - State:PA
Practice Address - Zip Code:18229-2207
Practice Address - Country:US
Practice Address - Phone:570-325-2991
Practice Address - Fax:570-325-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA065596Medicare ID - Type Unspecified