Provider Demographics
NPI:1437334075
Name:GREATER PITTSTON CHIROPRACTIC FIRST PC
Entity Type:Organization
Organization Name:GREATER PITTSTON CHIROPRACTIC FIRST PC
Other - Org Name:ADVANCED CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LINSKEY-FERENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-602-1590
Mailing Address - Street 1:3002 N TOWNSHIP BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSTON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3554
Mailing Address - Country:US
Mailing Address - Phone:570-602-1590
Mailing Address - Fax:570-602-1592
Practice Address - Street 1:3002 N TOWNSHIP BLVD
Practice Address - Street 2:
Practice Address - City:PITTSTON TWP
Practice Address - State:PA
Practice Address - Zip Code:18640-3554
Practice Address - Country:US
Practice Address - Phone:570-602-1590
Practice Address - Fax:570-602-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU90598Medicare UPIN