Provider Demographics
NPI:1386030047
Name:CASTRO CHIROPRACTIC SERVICES, LLC
Entity Type:Organization
Organization Name:CASTRO CHIROPRACTIC SERVICES, LLC
Other - Org Name:HOUSE CALL CHIROPRACTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-916-8192
Mailing Address - Street 1:7917 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17363-7905
Mailing Address - Country:US
Mailing Address - Phone:717-916-8192
Mailing Address - Fax:
Practice Address - Street 1:7917 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:STEWARTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17363-7905
Practice Address - Country:US
Practice Address - Phone:717-916-8192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOPHIA GRACE HOLDING CO.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty