Provider Demographics
NPI:1427218502
Name:PIASECKI CHIROPRACTIC MANAGEMENT
Entity Type:Organization
Organization Name:PIASECKI CHIROPRACTIC MANAGEMENT
Other - Org Name:84 CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:PIASECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-288-4665
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:EIGHTY FOUR
Mailing Address - State:PA
Mailing Address - Zip Code:15330-0259
Mailing Address - Country:US
Mailing Address - Phone:724-470-9600
Mailing Address - Fax:724-470-9569
Practice Address - Street 1:845 ROUTE 519 STE 3
Practice Address - Street 2:
Practice Address - City:EIGHTY FOUR
Practice Address - State:PA
Practice Address - Zip Code:15330
Practice Address - Country:US
Practice Address - Phone:724-470-9600
Practice Address - Fax:724-470-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11832765OtherCAQH
PA1782698OtherBLUE CROSS/BLUE SHIELD
PA1031415420001Medicaid
PA412022OtherUPMC