Provider Demographics
NPI:1487863296
Name:CARONE CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:CARONE CHIROPRACTIC, PC
Other - Org Name:DYNAMIC CHIROPRACTIC AND NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:VITO
Authorized Official - Last Name:CARONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-822-0071
Mailing Address - Street 1:1300 HORIZON DRIVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914
Mailing Address - Country:US
Mailing Address - Phone:215-822-0071
Mailing Address - Fax:
Practice Address - Street 1:1300 HORIZON DRIVE
Practice Address - Street 2:SUITE 111
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914
Practice Address - Country:US
Practice Address - Phone:215-822-0071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007768L111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0876977000OtherKEYSTONE
PA001612926OtherBLUE CROSS BLUE SHIELD
088868Medicare PIN
PA001612926OtherBLUE CROSS BLUE SHIELD
PACA088868Medicare ID - Type UnspecifiedGROUP#