Provider Demographics
NPI:1366007254
Name:DELEON'S CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:DELEON'S CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MAMAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DREYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-585-4290
Mailing Address - Street 1:402 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1062
Mailing Address - Country:US
Mailing Address - Phone:570-585-4290
Mailing Address - Fax:570-585-4299
Practice Address - Street 1:402 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1062
Practice Address - Country:US
Practice Address - Phone:570-585-4290
Practice Address - Fax:570-585-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016094150003Medicaid