Provider Demographics
NPI:1407151061
Name:KYTCHAK CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:KYTCHAK CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KYTCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-588-7550
Mailing Address - Street 1:418 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1773
Mailing Address - Country:US
Mailing Address - Phone:724-588-7550
Mailing Address - Fax:724-588-1788
Practice Address - Street 1:418 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1773
Practice Address - Country:US
Practice Address - Phone:724-588-7550
Practice Address - Fax:724-588-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty