Provider Demographics
NPI:1427373117
Name:ADVANCED CHIROPRACTIC OF STATE COLLEGE
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC OF STATE COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BECCUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-272-3555
Mailing Address - Street 1:341 SCIENCE PARK RD
Mailing Address - Street 2:SUITE203
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2287
Mailing Address - Country:US
Mailing Address - Phone:814-272-3555
Mailing Address - Fax:
Practice Address - Street 1:341 SCIENCE PARK RD
Practice Address - Street 2:SUITE203
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2287
Practice Address - Country:US
Practice Address - Phone:814-272-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty