Provider Demographics
NPI:1407037161
Name:YUSAVAGE FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:YUSAVAGE FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:YUSAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-489-9300
Mailing Address - Street 1:514 BURKE BYP
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1805
Mailing Address - Country:US
Mailing Address - Phone:570-489-9300
Mailing Address - Fax:570-489-2097
Practice Address - Street 1:514 BURKE BYP
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1805
Practice Address - Country:US
Practice Address - Phone:570-489-9300
Practice Address - Fax:570-489-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007540L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty