Provider Demographics
NPI:1306373857
Name:REDEFINED CHIROPRACTIC
Entity Type:Organization
Organization Name:REDEFINED CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAILEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-926-7078
Mailing Address - Street 1:681 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15557-1028
Mailing Address - Country:US
Mailing Address - Phone:814-926-7078
Mailing Address - Fax:814-926-7064
Practice Address - Street 1:681 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:PA
Practice Address - Zip Code:15557-1028
Practice Address - Country:US
Practice Address - Phone:814-521-7219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011246111N00000X
PAAJ011003111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty