Provider Demographics
NPI:1477754596
Name:KEYSTONE SPINE RESEARCH, SOMATIC STUDIES AND ORTHOPAEDIC THERAPY
Entity Type:Organization
Organization Name:KEYSTONE SPINE RESEARCH, SOMATIC STUDIES AND ORTHOPAEDIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-437-9020
Mailing Address - Street 1:111 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3607
Mailing Address - Country:US
Mailing Address - Phone:724-437-9020
Mailing Address - Fax:724-437-0295
Practice Address - Street 1:111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3607
Practice Address - Country:US
Practice Address - Phone:724-437-9020
Practice Address - Fax:724-437-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4928L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1043386OtherWV WORK COMP PROVIDER
PA351224OtherHIGHMARK BC BS GROUP NO
PA1539534OtherGATEWAY PROVIDER
PA1619126Medicaid
PA1539534OtherGATEWAY PROVIDER