Provider Demographics
NPI:1295826550
Name:SORBERA CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SORBERA CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:SORBERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-693-3730
Mailing Address - Street 1:1962 OLD ROUTE 220 N
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8305
Mailing Address - Country:US
Mailing Address - Phone:814-693-3730
Mailing Address - Fax:814-693-2160
Practice Address - Street 1:1962 OLD ROUTE 220 N
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8305
Practice Address - Country:US
Practice Address - Phone:814-693-3730
Practice Address - Fax:814-693-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007290L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA212547OtherPROVIDER IDENTIFICATION #
PA876048OtherPROVIDER IDENTIFICATION #
PA0017058600006Medicaid
PA975685OtherPROVIDER IDENTIFICATION #
PA876048OtherPROVIDER IDENTIFICATION #