Provider Demographics
NPI:1417288481
Name:SEWICKLEY CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:SEWICKLEY CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:YEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-741-5451
Mailing Address - Street 1:409 BROAD ST
Mailing Address - Street 2:SUITE 101 A
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1557
Mailing Address - Country:US
Mailing Address - Phone:412-741-5451
Mailing Address - Fax:412-741-5452
Practice Address - Street 1:409 BROAD ST
Practice Address - Street 2:SUITE 101 A
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1557
Practice Address - Country:US
Practice Address - Phone:412-741-5451
Practice Address - Fax:412-741-5452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 009739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty