Provider Demographics
NPI:1437440203
Name:ESTRAMONTE CHIROPRACTIC WEST PA
Entity Type:Organization
Organization Name:ESTRAMONTE CHIROPRACTIC WEST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ESTRAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-392-1338
Mailing Address - Street 1:4016 TRIANGLE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-2828
Mailing Address - Country:US
Mailing Address - Phone:704-392-1338
Mailing Address - Fax:704-398-0602
Practice Address - Street 1:4016 TRIANGLE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2828
Practice Address - Country:US
Practice Address - Phone:704-392-1338
Practice Address - Fax:704-398-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2579044OtherMEDICARE PTAN